Anatomy

Question 1

1)Triangles of the neck

2) Structures within triangles

Answer 1

1) Anterior - Horizontal ramus of mandible, Midline, SCM

Posterior - middle 1/3 Clavicle, trapezius, SCM,

Roof - Investing Fascia

Floor - Prevertebral fascia

2) Anterior -

Muscles - Supra + (Stylohyoid, digastric, myohyoid, geniohyoid) Infra (Omohyoid, sternohyoid, sternothyroid, thyrohyoid) hyoid muscles

Vascular - CCA, Carotid bifurcation, IJV

Nerves- VII, IX, X, XI, XII

Posterior -

Muscles - Omohyoid (Inferior belly), Vertebral muscles (scalenes, splenius, capitis, levator scapulae)

Vascular - EJV (empties into SCV), Subclavian Art (between ant. and mid. scalen) + Vein, Transverse Cerv. Art + Vein, Suprascapular ARt + Vein

Nerves - CN XI, Cervical Plexus, Phrenic Nerve, Brachial Plexus

Question 2

1) Subdivisions

2) Contents

Answer 2

1) Carotid - Posterior belly of digastric, Medial border of SCM, Superior belly of omohyoid

Submental - midline, Anterior belly of digastric, hyoid bone

Submandibular - Anterior belly of digastric, Posterior belly of digastric, mandible

Muscular - Hyoid, omohyoid + SCM, Midline

2)

Muscles - Supra + (Stylohyoid, digastric, myohyoid, geniohyoid) Infra (Omohyoid, sternohyoid, sternothyroid, thyrohyoid) hyoid muscles

Vascular - CCA, Carotid bifurcation, IJV

Nerves- VII, IX, X, XI, XII

Question 3

1) Subdivisions

2) Contents

Answer 3

1) Occipital Triangle- SCM, trapezius, Inf. belly of omohyoid

Subclavian triangle - SCM, mid 1/3 clavicle, Inf. belly of omohyoid

2)

Muscles - Omohyoid (Inferior belly), Vertebral muscles (scalenes, splenius, capitis, levator scapulae)

Vascular - EJV (empties into SCV), Subclavian Art (between ant. and mid. scalen) + Vein, Transverse Cerv. Art + Vein, Suprascapular ARt + Vein

Nerves - CN XI, Cervical Plexus, Phrenic Nerve, Brachial Plexus

Question 4

Suprahyoid Muscles

Name them, their attachments and innervation

Answer 4

1) Stylohyoid

Styloid process of temporal bone –> lateral hyoid

Innervated by a branch of CN VII

2) Digastric

2 bellies.

Anterior (Inferior Alveolar Nerve - CNV3) - digastric fossa of mandible.

Posterior (Facial Nerve) - styloid process of temporal bone.

Two bellies communicate via intermediate tendon which is trapped by a fibrous sling on thy hyoid bone.

3) Mylohyoid

Mylohyoid line of mandible –> hyoid bone.

Innervation from Inferior Alveolar Nerve of CNV3

4) Geniohyoid

Mental spine of mandible –> hyoid bone

C1 Nerve roots (Travel with CNXII)

Question 5

Infrahyoid Muscles

name them, their attachments and their innervations

Answer 5

Blood supply from Sup. + Inf. Thyr. Arteries

DEEP

1) Thyrhoyoid

Thyroid cartilage –> hyoid bone

Innervated C1 (travels within CNXII)

2) Sternothyroid

Manubrium –> thyroid cartilage

Innervated by Ansa Cervicalis (C1-C3)

SUPERFICIAL

3)Sternohyoid

Sternum/SCJ –> hyoid bone

Innervated by Ansa Cervicalis (C1-C3)

4) Omohyoid

Scapula (Inferior belly) –> hyoid (superior belly) via intermediate tendon anchored to deep cervical fascia

Innervated by Ansa Cervicalis (C1-C3)

Question 6

Submandibular Gland

1) Structures at risk during excision + deficit
2) Innervation

Answer 6

1) Lingual Nerve - Ipsilateral taste / sensation loss of anterior 2/3 tongue

Hypoglossal Nerve - Ipsialteral paralysis of the tongue

Facial Nerve (marginal Mandibular branch) - Ipsilateral weakness of lower lip and chin

2) Parasympathetic - CNVII –> Chorda tympani –> Then travels with lingual nerve before synpasing at submandibular ganglion. More volumous secretions

Sympathetic - Superior Cervical Ganglion then plexus follows arteries. Less volumous more enzyme rich secretions.

Question 7

1) Extrinsic Muscles (attachments + Innervations)

2) Intrinsic Muscles (Innvervations)

Answer 7

1) Extrinsic:

Genioglossus - Mandible –> Hyoid (+all of tongue)

Innervated by CN XII

Hyoglossus - Hyoid –> tongue (CN XII)

Styloglossus - Styloid process –>tongue (CNXII)

Palatoglossus - Palatine aponeurosis –> tongue (CNX)

2) Intrinsic Muscles

Superior longitudinal, inferior longitudinal, transverse + vertical

All innervated by CNXII

Question 8

Muscles attaching at 1-8

Ligaments 9-11

Answer 8

1 - Suprapinatous 2 - subscapularis 3 - Biceps (short) + Corachobrachialis

4 - Pec Minor 5 - Omohyoid 6 - Serratus Anterior

7 - Subscapularis 8 - Triceps (long)

9 - Coracohumeral ligament 10- coraco-acromial ligament 11 - suprascapular ligament

Question 9

Muscles 1 -14

ligament 15

Answer 9

1. Infraspinatous 2. Levator Scapulae

3. supraspinatous 4. Trapezius 5. Deltoid

6 Supraspinatous 7 Infraspinatous 8 Teres Minor

9 Long head triceps 10+11 - Teres Minor

12 - Teres Major 13 - Lat Dorsi 14 - Rhom. Major

15. Inferior Scapular Ligament

Question 10

1) Long head biceps

2) Trapezius (Attach/Innervation)

3) Lat Dorsi (Attach/Innervation)

4) Levator Scapulae (Attach/Innervation)

5) Rhomboids (Attach/Innervation)

Answer 10

1) Supraglenoid tubercle travels within the capsule

2) Skull, nuchal ligament + C7-T12 Spinous processes –> Acromion, Scapular spine + clavicle

Accessory Nerve

3) Spinous Processes T7-T12, iliac crest, inferior three ribs + lumbar fascia –> Intertubercular sulcus of humerus

Thoracodorsal nerve

4) C1-C4 spinous processes –> Medial scapular border.

Dorsal Scapular Nerve

5) C7-T1(Minor) T2-T5 (major) –> medial scapula

Dorsal scapular nerve

Question 11

1-9

Answer 11

1. Piriformis 2. glut. max 3. Quadr. Femori

4- origin of semitendinosus, biceps femoris

5 - gracilis 6 - semitendinosus 7. semimembranosus

8. Gracilis 9. Long head of biceps femoris

Question 12

10-19

Answer 12

10. Sciatic Nerve 11 Post. Cutaneous Nerve of thigh

12 ischial tuberosity 13 poplit. artery

14. polit. vein 15. SSV

16. Tibial Nerve 17. Common peroneal Nerve

18. Peroneal communicative nerve 19. sural nerve

Question 13

1-15

Answer 13

1. Piriformis 2. Quadratus Femoris

3. Origin of semitendinosis/ bicep fem. 4. Gracilis

5. Long head bicep fem. 6 Semitendinosis

7. Short head bicep fem. 8. Semimebranosous

9. Post. Cut. Nerve of thich 10. Sciatic Nerve

11. Ischial Tuberosity 12. Pop. ARt.

13. Pop. Vein 14. Srural Nerve 15. SSV

Question 14

Name all muscles, attachment and innervation of anterior thigh

Blood Supply

Answer 14

Sartorius - ASIS –> Medial tibia (pes anserius) femoral nerve

Pectineus - Anterior pelvis (pectineal line) –> posterior femur (pectineal line) femoral/obturator nerve

Psoas Major - Lumbar vertebrae has common tendon with iliacus –> lesser trochanter of femur (L1-L3 nerve roots)

Iliacus - Iliac fossa has a common tendon with psoas maj. —> lesser trochanter of femur (femoral nerve)

Quadriceps Muscles: (common insertion onto patella via quadriceps tendon) femoral nerve

Rectus Femoris - Ridge of iliac portion of acetabulum (superior to acetabulum)/ anterior inferior iliac spine

Vastus Medialis - Intertrochanteric line/medial linea aspera

Vastis intermedius - Anterior/Lateral Femoral Shaft

Vastus Lateralis - Greater trochanter/lateral linea aspera

Profunda Femoris

Question 15

Name all muscles, insertions and innervations of the posterior thigh

Blood Supply

Answer 15

Hamstrings -

Biceps Femoris -

Long head - Ischial tuberosity. tibial portion of sciat.

Short head - Linea aspera. fibular portion of sciat.

Common tendon inserts to head of fibula

Semitendinosus - ischial tuberosity to medial tibia. tibial portion of sciat.

Semimembranosus (deep to semitend.) - ischial tuberosity to medial tibial condyle. tibial portion of sciat.

Blood Supply - Inferior gluteal artery + profunda femoris artery

Question 16

Name all muscles, insertions and innervations of the medial thigh

Blood Supply

Answer 16

Adductor Magnus

Adductor port. - Inferior pub. rami + ischial rami –> linea aspera. obturator nerv.

Hamstring portion - Ischial tub. –> extends distally attaching to supracondylar line of fem. + adductor tubercle. tibial port. of sciatic n.

Adductor Longus -Pubis –>linea aspera. obturator n

Adductor Brevis (beneath longus)- pubis + inf. pubic rami –> linea aspera (prox. to longus) obtur. nerv.

Obturator Externus - obturator foramen –> post. aspect of greater. troch. obturator nerve

Gracilis - pubis + inf. pub. rami –> pes anserius (in between sartorius and semintendinosis) obturator nerve.

Blood supply - Obturator artery + perforating branches of the profunda femoris

Question 17

1-11

Answer 17

1. Pec Minor 2. deltoid 3. Pec major

4. Triceps 5. Biceps (long) 6. Biceps (short)

7. Corachobrachialis 8. Teres Major 9. Subscapularis

10. Lat. Dorsi 11. Serrat. Ant.

Question 19

12- 19

Answer 19

12. lat 1/3 clavicle 13. Axillary Vein.

14. Thoracoacromial Trunk

15. Circumflex scapular artery

16. Subscapular Art. 17. Axillary Artery

18. Thoracodorsal artery 19. Brachial Art.

Question 20

20-28

Answer 20

20 - Medial Cord 21 - Lateral Cord

22- Musculocutaneous n. 23 - Median n.

24 - Radial n.

25. thoracodrosal n. 26. median n.

27. Ulna N. 28. Medial cutaneous n. of forearm

Question 21

i) Gross heirarchy
ii) Describe formation from spinal cord to the plexus
iii) Describe derivatives of trunks
iv) Describe contributions to the cords and relative positions

Answer 21

i) Roots > Trunks > Divisions > Cords > Branches

ii) Derived from anterior rami of C5-T1 spinal nerves. They pass in between the anterior and medial scalene muscles just superior to the subcalvian artery

iii) Superior - C5-C6

• *Middle** - C7
• *Inferior -** C8-T1

Trunks cross laterally through the posterior neck triangle

iv) Cords are named relative to axillary artery. Trunks divide into ant. and post. divisions and enter axilla.

Lateral - Anterior Division of Superior + Middle Trunk

Posterior - Posterior Division of all trunks

Medial - Anterior Division of Inferior Trunk

Question 22

Brachial Plexus 2

i) Major Branches of the brachial plexus

ii) Minor branches of the brachial plexus and where they come from

Answer 22

i)

Lateral Cord - Musculocutaneous Nerve (C5-C7)

Posterior Cord - Axillary Nerve (C5-C6), Radial Nerve (C5-T1)

Medial Cord - Ulnar Nerve (C8-T1)

Medial + Lat. Cords - Median Nerve (C5/6-T1)

ii)

Roots - Dorsal Scap. Nerv (C5 - Rhomboids)

Long Thor. Nerve (C5-7 - Serratus Ant.)

Trunks - Suprascap. Nerv. (Upper Trunk- Supra+ Infraspinatus)

Nerve to Subclavius (Upper Trunk - subclavius)

Lat. Cord - Lat. Pect. Nerv. (Pec Major)

Med. Cord - Med. Pect. Nerv (Pec Min. + Maj)

Med. Cut. Nerve of forearm

Med. Cut. Nerve of arm

Post. Cord - Thoracodorsal Nerv. (Lat. Dorsi)

Sup. Subscapular Nerv. (subscapularis)

Inf. Subscapular Nerv. (Teres Maj. + subscapularis)

Question 23

The Axilla:

i) Boundaries

ii) Passageways exiting the axilla

iii) Contents of axilla

Answer 23

i)

Apex - Posterior clavicle, Sup. Scapula, First Rib

Latera- Intertubercular groove of humerus

Medial - Serratus anterior + thoracic wall

Posterior - lat dorsi, teres maj., subscapularis

anterior - pec major, minor, subclavius

ii)

1) Exit into upper arm (Lat. and inf.)
2) Qaudrangular Space

Lat. - Humerus, Med. - Triceps long head, sup. - teres minor. inf. - teres major

Transmits - Axillary n., post circumflex humeral vessels

3) Clavipectoral Triangle

Inf - pec Major Sup Lat. - Deltoid, Sup Med. - Clavicle

Transmits - Cephalic Vein, Deltoid branch of thoracoacromial art.

4) Lateral Triangular Space

Sup - Teres Maj Lat - Humerus med - Long head triceps

Transmits - Radial Nerve, Pronfuda brachii artery

iii) Axillary Contents:

• Axillary artery + branches
• Axillary veins + tributaries
• Axillary LNs
• Biceps (short) head, and corachobrachialis

Question 24

Subclavian Artery

i) Gross route
ii) Branches

Answer 24

i) R- arises from brachiocephalic trunk. RLN winds around this on the right side

L - Directly from aortic arch

1st part - Aorta –> Anterior Scalene

2nd part - Posterior to anterior scalene

3rd part - Anterior scalene to first rib

ii) VIT CD

1st -

Vertebral (Enter C6 transverse process travelling superiorly through foramen transversarium before enterring foramen magnum where they unite)

Internal Thoracic Artery (Intercostal branches, breast perforators, terminates as superior epigastric)

Thyrocervical trunk ( Inferior thyroid, Suprascapular, transverse cervical art.)

2nd - Costocervical Trunk (Sup. intercosta, deep cervical)

3rd Dosal Scapular Artery

Question 25

**Axillary Artery** i) Gross Route ii) branches

Answer 25

i) Continuation of subclavian art. as it passes border of first rib. beomes the brachial artery after the lower border of teres major Divisible into three parts **1st part -** Proximal to pec minor **2nd part -** Posterior to pec minor **3rd part -** Distal to pec minor ii) Screw the Lawyer, Save a patient **1st part -** Superior Thoracic Artery **2nd part** - Thoracoacromial artery (Pectoral, Acromial, Clavicular + Deltoid) Lateral Thoracic Artery **3rd Part -** Subscap. art. Ant. + Post. Circumflex arteries

Question 26

**Ear** i) Middle Ear Muscles ii) Parasympathetic Nerves running through/near ear

Answer 26

**i)** **Tensor Tympani** - Auditory tube --\> handle of malleus Mandibular Nerve V3 Dampens sounds **Stapedius** - Pyramid walls --\> Stapes **VII** Stabilises of stapes **ii) CNVII - Parasympathetic nerves to lacrimal glands.** Gives off the greater petrosal nerve to the pterygopalatine ganglion. From here postganglionic fibers travel with V2 branches to reach nasolacrimal glands/epithelium. Gives off the chorda tympani (joins lingual nerve) which synapses with the submandibular ganglion and innervates submandibular gland. **CNIX -** Tympanic branch innervates tympanic plexus. CNIX fibers then form lesser petrosal nerve synapsing with the otic ganglion. postganglionic fibers then travel with auriculotemporal nerve (V3 Branch) to innervate parotid + sublingual glands.

Question 27

**Label 1-13**

Answer 27

**1.** Helix **2.** Scapha **3.** Tubercle **4.** Antihelix **5.** Antitragus **6.** Earlobe **7.** Tragus **8.** Intertragic Notch **9.** External Meatus (cartilage) **10.** Crus of helix **11.** Crus of antihelix **12.** Triangular fossa **13.** Mastoid Process

Question 28

**Label 14-25**

Answer 28

**14.** Mallues **15.** Incus **16.** Stapes **17.** Manubrium **18.** Malleus **19.** Pars Flaccida **20.** Chorda Tympani **21.** Incus **22.** Umbo **23.** Pars tensa **24.** Annulus Fibrosis **25.** cone of light

Question 29

**Grossly Describe External Ear** **i) Visible** **ii) Describe external accoustic meatus** **iii) Tympanic Membrane** **iv) innervation of the external ear**

Answer 29

**i) Auricle -** Visible part of the ear. Upper auricle is cartilagenous while the lobe is not cartilagenous. **Helix** is the outer cartilagenous rim of auricle while the **anti-helix** is the inner cartilagenous rim **Concha-** Depression in middle ear continuing into the external accoustic meatus **Tragus and anti-tragus** - immediately at entry to the external accoustic meatus **ii) External accoustic meat.** runs from concha to the tympanic membrane in an s shape. **external 1/3 - cartilaginous** whereas the **internal 2/3** are formed by the temporal bone **iii) Tympanic memb.** - Connected to temporal bone by fibrocartilagenous ring. Handle of malleus attaches at **umbo**. **Pars tensa** spreads radially from the **handle of malleus** whereas **pars flacidda** is superior to the handle **iv)** Cervical Plexus - **Greater auricular nerve + Lesser occipital nerve** both supply skin of auricle **Auriculotemporal nerve** (CNV3), Facial Nerve + Vagal nerve supply skin of auricle and external accoustic meatus

Question 30

**Middle Ear** i) Gross Description ii) Borders iii) Bony components

Answer 30

i) Begins at tympanic membrane. Medially **is the tympanic cavity** whereas superiorly is the **epitympanic recess (next to the mastoid air cells)** Eustachian tube connects middle ear (ant. wall) to nasopharynx (lat. wall). ii) **Roof -** Petrous temporal bone adjacent to middle cranial cavity **Floor -** Petrous temporal bone. IJV adjacent **Lateral wall**- Tympanic Membrame **Medial wall -** Laterally borders inner ear. Facial Nerve Bulge **Anterior Wall -** Two openings - Auditory tube + tensor tympani. ICA adjacent **Posterior Wall -** Adjacent to mastoid cavity. Mastoid **aditus** allows communciation between middle ear and mastoid air cells **iii)** **Bony components transmit sound from tympanic membrane to the oval window** Malleus--\> Incus--\> Stapes

Question 31

**INner Ear** i) Gross anatomy ii) Describe balance organs iii) Describe auditory organs

Answer 31

**i)** **Grossly** the inner ear is comrpised of the **- bony** **labyrinth,** in the petrous bone formed by cochlea, vestibule (cochlea is anterior and semi circular canals are posterior) and 3 semi-circular canals. Lined by perilymph - **membranous labyrinth** is within the bony labyrinth. It is formed from saccule, 3 semi-circular ducts, cochlea duct and utricle. Lined by endolymph - **oval window** is between middle ear and vestibule, **round window** is betwene the middle ear and part of the cochlear duct iii) **Cochlea** houses the **cochlea duct.** **Modiolus** is central portion of bone in cochlea which communicates with CN VIII. **Spiral Lamina** portion of cochlea holds teh cochlea duct in place. **Scala vestibuli** superior to each **cochlea duct (**seperated from each other by reissner's membrane) and **scala** **tympani** inferiorly (seprated by basilar membrance **which houses organs of corti [specialised accoustic epithelium]).** Basement membrane essentially are the receptors of CNVIII. **iii) Saccule and Urticle** in the **vestibule** responsible for balance. **saccule -** vertical movement recevies the cochlea duct. **urticle** -horizontal movement receives the semicircular ducts.

Question 32

**Submandibular Gland 1** i) Location ii) (Once again) What is at risk during surgery iii) relation of facial artery and vein to submandibular gland

Answer 32

i) Posterior inferior to horizontal mandibular ramus in digastric triangle. ii) Marginal Mand. Nerve (Lip droop), Lingual Nerve, Hypoglossal Nerve iii) **Artery-** passes deep to the gland **vein** - passes superficial to the gland

Question 33

Submandiublar 2 1-12

Answer 33

**1.** Frontalis **2.** Obicularis Oculi **3.** Temporalis **4+5.** Levator Labii Superioris **6.** Orbicularis Oris **7.** Levator Angular Oris **8.** Zyg. Major **9.** buccinator **10.** Depressor anguli Oris **11.** Depressor Labii Inferioris **12.** masseter

Question 34

Submandibualr 3 13-25

Answer 34

**13.** parotid gland **14.** submandibular gland **15.** Horizontal body of mandible **16.** Facial Artery **17.** Sup. Temp. Artery **18.** Angular Vein **19.** Facial Vein **20.** IJV **21.** Stenson's (parotid) duct **22.** Temporalis Fascia **23.** Facial nerve (upper div.) **24.** VII Buccal branches **25.** VII Zyg. Branches

Question 35

The Nose 1-12

Answer 35

**1.** Frontal Bone **2.** Nasal Bone **3.** Superior Concha **4.** Sphenoid Sinus **5.** Pituitary GLand **6.** Middle Meatus **7.** Hiatus Semilunaris **8.** inferior Conchae **9.** inferior meatus **10.** nasopharynx **11.** tubular ridge **12.** opening of eustachian tube

Question 36

The nose 13

Answer 36

**13.** Adenoid **14.** Pharyngeal Recess **15.** Salpingopharyngeal fold **16.** Pharyngeal isthmus **17.** Hard palate **18.** Soft palate **19.** oral cavity **20.** oropharynx **21.** palatopharyngeal fold **22.** Palatoglossal fold **23.** Intrinsic tongue muscles **24.** Nares

Question 37

The nose 1-20

Answer 37

**1.** inferior meatus **2.** inferior conchae **3.** Hard palate **4.** soft palate **5.** Pharyngeal isthmus **6.** palatopharyngeal fold **7.** palatoglossal fold **8.** oral cavity **9.** Fungiform papillae **10.** Vallate papillae **11.** oropharynx **12.** lingual tonsils **13.** intrinsic tongue muscles **14.** Genioglossus **15.** geniohyoid **16.** epiglottis **17.** piriform fossa **18** Vallecular **19.** hyoid bone **20** laryngeal inlet

Question 38

**Broad divisions of oral/ nasal cavity**: 1) Nasal Cavity 2) Nasopharynx 3) Oral cavity 4) Oropharynx 5) Laryngopharynx

Answer 38

1) Nares--\> imaginary line through start of soft palate and base of skull 2) Ends at a line drawn between uvula (end of soft palate and base of skull) 3) Lips to level of anterior epiglottis 4) Anterior border - Line between uvula and anterior epiglottis Superior - level of uvula inferior - level of hyoid bone 5) hyoid bone to the level of trachea/oesophageal divergence

Question 39

Oropharynx 1-13

Answer 39

**1.** Pituitary Gland **2.** sphenoid Sinus **3.** Middle Concha **4.** Adenoids **5.** Nasopharynx **6.** Auditory Tube Opening **7.** Pharyngeal recess **8.** tubal ridge **9.** salpingopharyngeal fold **10.** Soft palate **11.** Uvula/pharyngeal isthmus **12.** palatoglossal fold **13.** palatopharyngeal fold

Question 40

Oropharynx 14-26

Answer 40

**14.** Oropharynx **15.** Post. Pharyng. Wall **16.** Lingual Tonsil **17.** Epiglottis **18.** Laryngopharynx **19.** Hyoid Bone **20.** Vestibular Fold (false cords) **21.** Laryng. Sinus **22.** Vocal Fold (true cord) **23.** Trachea **24.** Oesophagus **25.** Retropharyngeal Space **26.** Piriform fossa

Question 41

Oropharynx 27-38

Answer 41

**27.** Anterior arch of atlas **28.** Dens **29.** C3 Body **30.** Basilar ARt. **31.** Vertebral art. **32.** PICA **33.** Pons **34.** medulla oblongata **35.** Cerebellum **36.** 4th Ventricle **37.** Cisterna Pontis **38.** Central Canal

Question 42

Anterior Neck Anatomy 1-14

Answer 42

**1.** Parotid Gland **2.** Submandibular Gland **3.** masseter **4.** Platysma **5.** Mylohyoid **6.** Anterior Belly Digastric **7.** Posterior belly digastric **8.** Hyoid Bone **9.** Omohyoid (Sup. Belly) **10.** Sternohyoid **11****.**thryohyoid**12.** SCM **13.** Clavicle **14.** Deltoid

Question 43

Anterior Neck Anatomy 2 15 - 30

Answer 43

**15.** Pec Major **16.** Scal. Ant. **17.** Scal. Med **18.** Inf. belly Omohyoid **19.** Levat. Scapul. **20.** Semispinal. **21.** Facial nerv. **22.** Int. Jug Vein **23.** Ansa Cervicalis **24.** EJV **25.** Carotid Sinus **26.** ICA + ECA **27.** Hypoglossal N. **28.** Accessory N. **29.** subscapular art. **30.** Thyrohyoid Nerve.

Question 44

**What covers the roof + floor of the anterior neck triangle**

Answer 44

**Roof -** Investing fascia **Floor-** Visceral Fascia

Question 45

**Larynx** i) Cartilage types in the larynx

Answer 45

i) **Epiglottis -** Elastic **Thyroid, Cricoid, Aryetonoids, corniculate, cuneiform --\>** Hyaline

Question 46

Larynx anatomy 1-9

Answer 46

**1.** Fungiform Papillae **2.** Vallate Papillae **3.** Foramen Caecum **4.** Sulcus Terminalis **5.** epiglottis **6.** laryngeal inlet * *7.** valleculae **8.** Posterior Pharyngeal Wall * *9.** Piriform Fossa

Question 47

Larynx Anatomy 2 10-18

Answer 47

**10.** Arytenoid Cartilage / Fold **11.** Laryngopharynx **12.** Vestiublar Fold ( False Cord) **13.** Vocal Fold (true cord) **14.** Glottis **15.** Cricoid Cartilage **16.** Trachea **17.** oesophagus **18.** Lingual Tonsils

Question 48

**Posterior Triangle** 1-13

Answer 48

**1.** parotid **2.** Submandib. LNs **3.** posterior belly of digastric **4.** Submand. Gland **5.** SCM **6.** Splenius Capitis **7.** Levator Scap. **8.** trapezius **9.** Scal. medius **10.** Scal. Post. **11.** ECA **12.** Facial Art. **13.** CCA

Question 49

**posterior triangle**

Answer 49

**14.** Greater Auricular N. **15.** Hypoglossal N. **16.** Cervical Plex. **17.** Transv. Cerv. N. **18.** Brachial Plex (upper trunk) **19.** Suprascapular N. **20.** Phrenic n. **21.** Supraclavicular N. **22.** Lesser occipital n.

Question 50

**Accessory N.** i) Course ii) Innervates iii) Testing weakness

Answer 50

i) Exits skull vault through Jugular Foramen. Passess deep to SCM and stays near trapezius. ii) innervates SCM + Trapezium iii) Trapezius - Shrug SCM - Resisted turning head (If left turn is weak then contralateral [right] CNXI is damaged)

Question 51

**Parotid Anatomy**

Answer 51

**1.** Orbicularis Oculi **2.** Zygomaticus Major **3.** Zygomaticus Minor **4.** Levator Angular Oris **5.** Orbicularis Oris **6.** Depressor ANgular Oris **7.** Platysma **8.** Masseter **9.** SCM **10.** Parotid Gland **11.** parotid duct (stenson's) **12.** Accessory Parotid gland **13.** Superficial Temporal Art. **14.** Facial ARtery. **15.** Facial Vein **16.** Angular Vein **17.** Facial N. Upper Div. **18.** Temporal N. **19.** Zygomatic N. **20.** buccal N. **21.** Marginal Mandib. N. **22.** cervical n.

Question 52

**Clavicle** **Label 1 - 6** **What ataches 7-15** **Name articulation 16-17**

Answer 52

**1.** Acromial End **2.** Ant. Border **3.** post. border **4.** conoid tubercle **5.** shaft **6.** sternal end **7.** Trap. **8.** Delt. **9.** SCM **10.** Pec Maj. **11.** Subclavius **12.** Interclavicular lig **13.** Trapezoid portion of coroclavicular lig. **14.** Conoid portion of coroclavicular lig. **15.** Costoclavicular ligament **16.** Sternum ARticulation **17.** Acromion Articulation

Question 53

**Subclavian Art.** Define the three parts Branches and where they arise Branches of the Branches

Answer 53

**i) Parts:** 1 - origin to scalenus anterior (medial border) 2 - behind scalenus anterior 3 - from lateral borer of scalenus anterior to 1st rib **ii) Branches:** **1st Part -** Vertebral, Internal Thoracic, Thyrocervical **2nd Part** - Costocervical, Dorsal Scapular **iii) B of Bs** **Verebtral** - Ant. + Post. Meningeal arteries, 1 x Ant spinal artery, 2 x Post Spinal ARtery, PICA (End as they converge to form basillar artery) **Internal Thoracic Artery** - terminates as musculophrenic artery + superior epigastric artery **Thyrocervical Trunk** - Inf. Thyroid Ard, Suprascapular art., Transverse cervical art., ascending cervical art. **Costocervical trunk** - Terminates as deep cervical artery, sup. intercostal art.

Question 54

**Ribs** i) How do they articulate with sternum ii) Where is the intercostal bundle? iii) Which rib has 2 tubercles iv) Describe relations to the scalene tubercle

Answer 54

**i) 1-7 -** Have individual costal cartilage **8-10** - Have shared costal cartilage **11-12 -** have no costal cartilage **ii)** intercostal bundle exists in a groove on the lower surface of the rib **iii)** First rib - Scalene Tubercle and costal tubercle **iv) Ant.** to the tubercle is the groove for the subclavian vein **Post.** to the tbercle is the groove for subclav. art. + lower trunk of brachial plexus

Question 55

**Clavicle** Where do the major muscles attaching to the clavicle attach.

Answer 55

**Superior Surface:** **Acromial End** - Trapezius (posterior) - Deltoid (anterior) **Sternal End** - Sternocleidomastoid (posterior) - Pec Major (anterior) **Inferior Sruface:** - Subclavius muscle

Question 56

**Intercostal** **i) Muscles how many are there - name then** **ii) Where is the intercostal bundle - name the structures from the top downwards**

Answer 56

**i) Three** **External** - Downwards and forwards (inhalation) **Internal** - Downwards and backwards (exhalation) Innermost - Transversus thoracicus (ant.), lateral slips (lat.), subcostalis (post.) Fibers of **internal** and **external** intercostal muscles run in opposite directions. **ii) Run in a groove beneath rib in between the innermost and internal intercostal muscles** (Most Superior) Vein, Artery, Nerve

Question 57

**Label** 1-12

Answer 57

**1.** Thoracic Aorta **2.** Thoracic Duct **3.** Ayzgous vein **4.** Sympathetic trunk **5.** Intercostal Vein, **6.** Int. ARt. **7.** Int Nerve **8.** Sup. Intercostal Vein **9.** Vertebral Body **10.** Vertebral Disc **11.** Rib **12.** Innermost intercostal muscle

Question 58

**Label 1-19**

Answer 58

**1.** Trachea **2.** Inf. Thyroid Vein **3.** Trachea **4.** R. Main Bronch. **5.** L. Main Bronch. **6.** Subcarinal LNs **7.** Oesophagus **8.** Aortic Root **9.** Brachiocephalic Trunk **10.** Ext. Carotid Art. **11.** Subclav. Art. **12.** Internal Thoracic ARt. **13.** Costocervical Trunk **14.** Subclav Art. **15.** Common Carotid Art. **16.** R Vagus **17.** L Vagus **18** R phrenic trunk **19** R Sympathetic trunk

Question 59

**Trachea** i) What level does it originate and divide? ii) relations of trachea in neck iii) What are the walls of the trachea made of?

Answer 59

i) Originates at C6 (lower border of cricoid cart.) and divides at T4 (carina is behind angle of louis) ii) **ant.** Thyroid, inf. thyr. vein, sternohyoid, sternothyroid **post.** Oesophagus, RLN in oesophagatracheal groove **lat.** carotid sheath, lateral thyr. lobes iii) Walls of trachea are made of: - C shaped cartilage anteriorly + laterally - Membranous wall posteriorly with trachealis muscle

Question 60

**Angle of Louis** i) What vertebral level ii) What anatomical releavance

Answer 60

i) **Level of T4/T5 Vertebrae** ii) Carina, Start+ End of aortic arch Aygos drains into SVC, THoracic Duct crosses R -\> L behind oesophagus Division of Sup/Inf Mediastinum L RLN loops behind aortic arch

Question 61

Label 1-12

Answer 61

**R Lung** **1.** Upper Lobe. **2.** Lower Lobe **3.** Middle lobe **4.** Apex **5.** Base **6.** Horizontal Fissure **7.** Oblique Fissure **8.** impresion of subcl. art. **9.** impression of 1st rib **10.** impression of azygous vein **11.** Right Atrium **12.** Pul Arteries **13.** Bronchus **14.** Pul Veins

Question 62

Label 1-13

Answer 62

**1.** Upper Lobe **2.** Lower Lobe **3.** Apex **4.** Lingula **5.** Base **6.** Oblique Fissure **7.** Impression for 1st Rib **8.** impression for Subclav. ARt **9.** Impression for Aorta **10.** Impression for L Ventricle **11.** Pul. Art. **12.** Bronchus **13.** Pul Vein

Question 63

**Pulmonary Artery** **i) Course of R Pul ARt.** **ii) Course of L Pul Art**

Answer 63

i) Arise from pulmonary trunk. Passes **in front of oesophagus** **behind ascending aorta/ SVC** then at the root it passes between **R Main Bronchus and Upper lobe bronchus** Divides into ther branches (lobar) ii) Arises from PT. Connected to aortic arch by ligamentum arteriosium. Passes in **front of the** **descending aorta/ L Main Bronchus**

Question 64

**i) Describe the pleural cavity** **ii) Describe hiccough reflex** **iii) Surface markings of pleura** **iv) Surface markings of lung**

Answer 64

i) Potential space in between **visceral pleura** (covering the lungs, vessels, bronchi + nerves) and the **parietal pleura** (attached to the chest wall - endothoracic fascia) . ii) **HIccough** is caused by phrenic nerve (+its distribution) irritation leading to contractions of the daiphragm iii) **2nd rib** - are converged and then diverge again at the **4th rib. 6th rib** parasternal **8th rib** mid clavicular **10th rib** mid axillary **12th rib** converge at erector spinae iv) **6th rib** mid clavicular line **8th rib** mid axillary line **10th rib** Erector Spinae

Question 65

Lungs Label

Answer 65

**1.** Upper Lobe **2.** Midle lobe **3.** lower lobe **4.** Upper Lobe **5.** Lower Lobe **6.** Manubrium **7.** Diphragm **8.** R Lobe Liver **9.** L Lobe Liver **10.** Falciform Ligament **11.** R Apex **12.** R Horizontal Fissure **13.** R Oblique Fissure **14.** L Apex **15.** L oblique fissure **16.** Int. Thorac. Art. **17.** Costal (parietal) Pleura **18.** Mediastinal (parietal) pleura **19.** Fibrous Pericardium (Superficial to parietal pleura) **20.**

Question 66

**Innervation of** Visceral Pleura Parietal Pleura Diaphragm

Answer 66

**Visceral Pleura -** Supplied by vagus nerve **Parietal Pleura -** Supplied by intercostal nerves **Diaphragm -** Phrenic nerve (C3-C5) Parietal pleura and diaphragm both have pain receptors whereas the visceral pleura does not.

Question 67

**Diaphragmatic Openings and their occupants, what else goes through diaphragm** **Diaphragmatic embyrology - 4 components**

Answer 67

i) **T8** Caval Foramen (Central tendon) Contains - IVC + R Phrenic Nerve (L pierces diaphragm directly) ii) **T10** Oesophageal Foramen (R Crus) Contains- Oesophagus, L Gastric A+V, Vagus trunks iii) **T12** Aortic Foramen (Behind diaphragm) Contains - Abdominal Aorta, Thoracic Duct, Azygos Vein iv) L Phrenic Nerve, Splanchnic nerves, Superior epigastric vessels, Sympahetic chain (Behind median arcuate ligament) **Embryologically diaphragm forms from fusion of -** Septum Transversum, Foregut Mesentery, Ingrowth from body wall, Pleuroperitoneal membrane **Septum Transversum** forms **Central Tendon** **Foregut Mesentery** forms **oesophageal opening + crura**

Question 68

**Diaphragm**

Answer 68

**1.** IVC **2.** Oesophagus **3.** Aorta **4.** Renal Art. **5.** Coeliac Art. **6.** SMA **7.** Pericardiophrenic Art. **8.** Inf. Phrenic Art. **9.** Costal Fibers of diphragm **10.** R Crus **11.** L Crus **12.** Median Arcuate Lig. **13.** Central Tendon **14.** Sternal Diaphragm Fibers **15.** L Renal Vein

Question 69

**Types of diaphragamatic hernias**

Answer 69

Through **Bochdalek** Foramen - Left usually (through pleuroperitoneal membrane) Through **Morgagni** foramen - Anterior through xiphoid and costal origin Can also herniate through - **large** oesophageal foramen + through deficient **central tendon**

Question 70

**Mediastinum** i) Divisions of the mediastinum

Answer 70

i) Imaginary line through the sternal angle seperates the **superior (to the thoracic arpeture)** and **inferior (to the diaphragm)** mediastinum. **Superior - Anteriorly -** Manubrium to sternal Angle **Posterior** - T1 - T4 Vertebrae **Anterior -** **Between sternal angle and diaphragm (**anteriorly chest wall, posteriorly the pericardium) **Middle** - Pericardium **Posterior** - Anteriorly pericardium, Posteriorly vertebrae, superiorly sternal angle, inferiorly the diaphragm

Question 71

**Contents of:** **i) Sup Mediastinum** **ii) Ant. Mediastinum** **iii) Mid Mediastinum** **iv) Post. Mediastinum**

Answer 71

i) **Vessels**- Arch of aorta + branches, SVC + tributaries( Azygos, brachiocephalic, supreme intercost., L Sup. intercostal) **Nerves** - phrenic (ant. to ant. scalene), R Vagus (Post. to SVC and R main bronch.), L Vagus (Ant. to Aortic ARch and post. to L Main bronchus), Cardiac Nerves, Sympathetic Trunk **Muscles**- Sternohyoid, Sternothyroid **Others**- Thymus, Trachea, Oesophagus, Thoracic Duct ii) Sternopericardial Ligaments (+thymus - mainly in children iii) **Vessels-** Ascending Aorta, SVC, Pulmonary Trunk **Nerves -** Cardiac plexus, Phrenic Nerves **Others -** Heart, Tracheobronchial LNs, Primary Bronchi (+carina) iv) **Vessels -** Descending aorta + branches (9 paired post. intercostal, 1-2 Paired bronchial arteries, 1-2 unpaired oesophageal arteries, Sup. phrenic arteries), Azygous System **Nerves -** L+R Vagus Nerves ( form oesophageal plexus and then as leaving diaphragm converge to form L+R Vagal Trunks), Sympathetic Trunks **Others -** Oesophagus (posterior to aortic arch / aorta), Thoracic Duct (Anterior to vertebral bodies),

Question 72

**Describe Azygous System** **Importance in IVC Obstruction?**

Answer 72

**In the posterior mediastinum:** **Azygous vein** - Formed from R Lumbar + R Subcostal veins. Enters with aorta through aortic hiatus. Essentially drains the posterior lumbar and thoracic wall **Hemiazygous vein** - Formed from L Lumbar L subcostal vein. Enters through L crus of diaphragm. At T8 crosses vertebrae and drains into ayzous vein. **Accessory Hemiazygous Vein** - Formed from L 4th-8th intercostal veins. Crosses at T7 to drain into Azygous Vein. **The ayzgous vein** empties into the **SVC by** passing **over** the **R Main Bronchus** at the root of the lung. **IVC obstruction -** There is collateralisation through the azygous system to the SVC through: Lumbar Azygous Veins (between renal veins and azygous veins) which form communication between IVC and azygous vein (at its origin)

Question 73

Heart Anterior

Answer 73

Question 74

**Heart Vasculature:** i) How many Pulmonary Veins are there? ii) SVC Course? iii) What is the coronary sulcus? iv) what are the interventricular sulci? v) What are the pericardial sinuses?

Answer 74

i) 2 Pairs of pulmonary veins - 1 inferior + 1 superior all draining into L Atrium ii) SVC formed by **unification** of both **brachicephalic** **veins**. The SVC travels laterally to the right mediastinum and then pierces the **middle mediastinum** before emptying into the **right atrium.** iii) Groove running circumferentially around the heart 'seperating' the atria from the ventricles iv) Running vertically down the surface of the anterior + posterior aspcts of heart v) Sinuses are formed from folds of the pericardium. **oblique** sinus - on posterior surface of heart **trasnverse sinus** - Posterior to the ascending aorta + pulmonary traunk / Anterior to the SVC. Seperates the main arteries/veins

Question 75

**Heart anatomy atria :** i) Divisions of R Atrium ii) what is the fossa ovalis a remnant of? iii) gross description of L atrium

Answer 75

i) **Divided** by the **crista terminalis** (muscular ridge) into the **sinus venarum** (posterior to CT) and the **atrium proper** (anterior to CT) which has pectinate muscles. **Coronory Sinus** also opens into the right atrium ii) **Fossa Ovalis** is a remnant of the **foramen ovale** in between the R and L atriums on the interatrial septum. iii) Posterior border of the heart. Superiorly is the **l auricle.** Two portions of the L atrium (interior) - **posterior** is the **inflow** portion receiving blood from PVs and the **anterior** is the **outflow** portion which is lined by pectinate muscles.

Question 76

**Heart Anatomy (Ventricles):** i) Different features of ventricle walls ii) How many papillary muscles on R ventricle / L VEntricle iii) What are the outflow tract of R and L Ventricle called

Answer 76

i) **Trabeculae Carnae -** are a series of muscular elevation predominantly in inflow tracts. Different types are - **Papillary Muscles -** are attached to the tricuspid/mitral valve by **Chordae Tendinae.** They contract to prevent valve prolapse during ventricular systole **Ridges + Bridges (**Important example of a bridge is the moderator band of R Ventricle) **Supraventricular Crest -** Divides inflow and outflow portion of the R Ventricle ii) **3 - on right** as tricupid has 3 leaflets **2 - on left** as mitral has 2 leaflets **iii)** **Conus Arteriosus -** is the outflow tract of the R Ventricle where as the **L Vetnricle** outflow tract is called the **aortic vestibule.** Both develop from the **bulbus cordis.**

Question 77

**Cardiac Conducting System** i) Where is SA node ii) What is the PR interval caused by? iii) What happens beyond the AV node? Describe the components iv) Where might you find pacemaker leads?

Answer 77

i) **Sinoatrial Node** is in the wall of right atrium near the SVC ii) **PR interval** is caused by delayed conduction in the **atrioventricular node** situated in the **atrioventricular septum** near the coronary sinus iii) **Immediately** after the AV node is the **bundle of his** within the interventricular septum. This then branches into the **Right and Left Bundle.** **Right Bundle -** Only 1 Fascilce **Left Bundle -** Anterior and Posterior fasicle. The bundles then continue to the apex of the heart from where purkinje fibers begin to extend into the subendocardium disseminating action potential to myocardium. iv) **Right ventricle lead -** practically all devices **Right atrial lead -** dual chamber devices **Coronary Sinus lead -** Biventricular devices

Question 78

**Pericardium** i) Layers ii) innervation

Answer 78

i) **Fibrous Pericardium -** Continuous with central tendon of diaphragm. Non distensible **Serous Pericardium -** Seperated into - **Parietal Pericardium** **Visceral Pericarium -** Also known as the epicardium ii) **Innervated by the phrenic nerve**

Question 79

**Coronary Vasculature** **i) Describe the coronary arteries**

Answer 79

**i)** Aortic Sinuses are behind the aortic valve leaflets and blood enters this in diastole. Aortic Sinuses go on to form the: **Left Coronary Artery + Right Coronary Artery** **Left coronary artery** gives **three branches(or four):** **Left Anterior Descending (Anterior Inteventricular groove. AKA Anterior Interventricular Artery)** **Left Circumflex ARtery (In the coronary sulcus. Gives rise to the L Marginal Artery)** (rarely **the posterior interventricular artery)** **Right Coronary artery** (runs in the coronary sulcus) gives **two branches (or one):** **Right Marginal Artery** **Posterior Interventricular Artery** (Post. IV Groove) **ii)** Veins eventually drain into the **coronary sinus** (located posteriorly on the **coronary sulcus** which in turn drains into the **R atrium** ) Anterior Veins are the : **Great Cardiac Vein -** In anterior interventricular groove **Small Cardiac Vein -** Right Sided Posterior vein is the : **Middle Cardiac Vein** **Left Marginal Vein** **Left posterior ventricular vein**

Question 80

Heart B

Answer 80

Question 81

Label 1 - 16

Answer 81

**1.** Iliac Crest **2.** Iliac Tubercle **3.** ASIS **4.** Gluteal Fossa **5.** Body of Ilium **6.** Lunate surface **7.** Acetabular Fossa **8.** Acetabular Notch **9.** Ischial Tuberosity **10.** Ischial Body **11.** ischial spine **12.** AIIS **13.** Iliac Fossa **14.** Iliac Tuberosity**15.** PSIS **16.** PIIS

Question 82

Label 17-32

Answer 82

17. Arcuate Line **18.** Iliopubic eminence **19.** Pubic tubercle **20.** pubic crest **21.** pubic symphysis **22.** Inf. Pub. Ramus **23.** Ischial Ramus **24.** Obturator Crest **25.** Lesser Sciat. Notch **26.** Greater Sciat. Notch **27.** Groove for obturator Externus **28.** Post. Gluteal Line **29.** Inf. Gluteal Line **30.** Ant. Gluteal Line **31.** Obturator foramen **32.** Obturator groove

Question 83

**Greater Sciatic Foramen** **i) Boundaries of greater sciatic foramen** **ii) Structures passing through the GSF**

Answer 83

i) Anterolateral - Greater Sciatic Notch of ilium Posteromedial - Sacrotuberous ligament Inferior- Sacrospinous lig and ischial spine Superior - Ant. Sacroiliac ligament ii) **Piriformis runs through and 'divides the GSF'** **Total - 7 nerves, 3 Vascular Sets + Piriformis** **Above Piriformis** Superior Gluteal Vessels + Nerve **Below Piriformis** Vascular - a) Inf Gluteal Vessels b) Int. Pudendal vessels Nerves - a) Sciatic Nerve b) Inf. Glut. Nerve c) Pudendal Nerve d)Post. Fem. Cutaneous Nerve e) Nerve to obturator Internus f) Nerve to quadratus femoris

Question 84

i) Blood supply to the hip joint ii) Attachment of capsule to the femur iii) Extracapsular/Intracapsular hip ligaments

Answer 84

**i) Principally three arteries:** **Medial Circumflex Femoral Artery** (largely) **Lateral Circumflex Femoral Artery** **Artery to head of femur** (branch of obturator artery with minor contribution) **Medial and lat circ** branch of **profunda femoris artery** **ii)** Has both ant. and post. femoral attachment **Ant.** - Intertrochanteric Line **Post.** - More proximal on femoral neck **iii) Iliofemoral Ligament** -AIIS -\>Intertrochanteric line **Pubofemoral Ligament** - Superior pubic rami -\> Intertrochanteric Line (triangular shape) **Ischiofemoral Ligament** - Body of ischium -\> Greater trochanter (Spirals)

Question 85

Femur Anatomy Label 1-11

Answer 85

**Attachment for:** **1.** Gluteus Minimus **2.** Piriformis **3.** gluteus medius **4.** Quadratus Femoris **5.** Iliopsoas **6.** Glut. Max. **7.** Vastus Lateralis **8.** Vastus Medialis **9.** Obtur. Internus + Gemellae **10.** Iliofemoral lig. **11.** Lig. Teres

Question 86

**Name Muscles:** **i) Flexing hip point** **ii) Short external rotators** **iii) Abducting the hip joint**

Answer 86

i) Iliopsoas, Pectineus, Sartorius, Rectus Femoris ii) Superior to Inferior. Piriformis, Sup. Gemelli, Obt. int. + Ext., Quadr. Fem. iii) TFL, Glut. Med + Min

Question 87

**Iliopsoas** **Origin** **Insertion** **Innervation**

Answer 87

**Origin -** Iliac Fossa, T12 - L5 vertebrae **Insertion -** lesser trochanter **Innervation -** Femoral Nere (+L1-L2)

Question 88

**Origin, Insertion + Inneration of** **Glut. Med, Min + TFL**

Answer 88

**Innervated -** Superior Gluteal Nerve (L4-S1 Sacral Plexus) **Glut Med + Min -\>** Glut Fossa of Ilium -\> Greater trochanter **TFL -\>** Iliac Crest -\> IT Band

Question 89

Gluteal Region ## Footnote **Label Muscles 1-8** **Origin 9** **Fascia 11-12** **Ligament 13** **Structures 14-16** **Label 17-24**

Answer 89

**1.** Glut. Max. **2.** Glut Med. **3.** Glut. Min. **4.** Piriformis **5.** External Obliq. **6.** Obt. Extern **7.** Obt. Int./ Gemellae **8.** Levator Ani **9.** Hamstring Origin **10.** Iliac Crest **11.** Gluteal Fascia **12.** Lumbar Fascia **13.** Sacrotuberous ligament **14.** Ischial Tuberosity **15.** Greater Trochanter **16.** Hip Joint Capsule **17.** Sup. Glut. Art. **18.** Sup. Glut. Nerve. **19.** Inf. Glut. Nerve **20.** Inf. Glut. ARt. **21.** Post. Cut. Nerve of thigh **22.** Sciatic Nerve (L4-S3) **23.** Inf. Rect. Nerve **24.** Cutaneous branches of lumbar dorsal rami

Question 90

**Sciatic Nerve** **i) Roots** **ii) Course** **iii) Innervates**

Answer 90

**i)** L4-S3 **ii)** Ventral Rami L4-S3. Leave pelvis through GSF below piriformis. Travels beneath glut max traversing inferiorly between the greater trochanter and ischial tuberosity. Travels superficially to adductor magnus before enterring poplital fossa. **iii)** **Hamstring Muscles** **Adductor Magnus (tibial portion)** **External Rotators (Gemellae, Obt. Internus, Quad. Femor.)** **Then --\>** **Common Peroneal Nerve :** Ant. + Peroneal comparments **Tibial nerve:** Deep and Superficial Posterior Compartments **sensation to** posterior thigh and lateral leg

Question 91

Post. Knee. Label

Answer 91

**1.** Med. Fem. Condyle **2.** lat. Fem. Condyle **3.** Fibular Head **4.** Med. Meniscus **5.** Lat. Meniscus **6.** Post. Meniscofem. Lig **7.** Post. Cruc. Lig **8.** popliteus **9.** Lat. Collateral Lig. **10.** Prox. Tibiofibular Joint **11.** Femur **12.** Patella **13.** Tibia **14.** Fat Pad **15.** Quadriceps Tendon **16.** patella tendon **17.** Suprapatellar bursa

Question 92

Knee Label 2

Answer 92

**1.** Lat. Fem. Condyle **2.** patella **3.** Tib. Tuberosity **4.** Quad. Tendon **5.** Patel. Tendon **6.** Lat. Meniscus **7.** Lat. Colat. Lig **8.** Bicep Femoris (Reflected inferiorly) **9.** Popliteus **10.** Lat. Head of gastroc. + plantaris **11.** Tibial Nerve **12.** Common Peroneal Nerve **13.** Med. Fem. Conyle **14.** Vastus Medial. **15.** Hamstring tendon portion of add. magnus **16.** Adductor Tubercle **17.** Gracilis **18.** Sartorius **19.** Semitendinosis **20.** Pes Anserina **21.** Medial Gastrocnemius **22.** Tibia **23.** Med. Collat. Lig. **24.** Adductor Hiatus

Question 93

**Knee Joint (Left)** **Label 1-14**

Answer 93

**1.** Patella Groove **2.** Sup. Lat. Fem. Condyle **3.** Sup. Med. Fem. Condyle **4.** Med. Fem. Condyle **5.** Lat. Fem. Condyle **6.** Med. Tib. Condyle **7.** Lat. Tib. Condyle **8.** intercondylar eminence **9.** Tib. Spine **10.** Intercondylar Notch **11.** ACL **12.** PCL **13.** Lat. Meniscus **14.** Med. Meniscus

Question 94

**Where do they attach:** i) ACL ii) PCL iii) MCL iv) LCL v) Which nerve/artery is commonly injured in knee dislocation?

Answer 94

**i) ACL -** Lat. Condyle of femur -\> Anterior intercondylar area **ii) PCL -** Med. Condyle of femur -\> Post. intercondylar area **iii) MCL -** medial epicondyle of femur -\> med tibial condyle Part of the MCL directly communicates with the medial meniscus **iv) LCL -** lateral epicondyle of femur -\> fibular head seperate from lateral meniscus **v)** Common peroneal nerve - roughly 15% Popliteal Artery - roughly 10%

Question 96

**Popliteal Fossa:** **i) Boundaries** **ii) Contents** **iii) Where do the Popliteal LNs drain?**

Answer 96

**i) Superior** Lateral - Bicep Fem Medial - Semi memb/tend **Inferior** Med/Lat - Gastrocnemius **Roof -** Fascia Lata **Floor -** Post knee joint capsule + poplitues musc. **ii) Contents:** (superficial to deep) **Nerves (most superficial)** - Common peroneal nerve - Medial to bicep fem tendon. Tibial Nerve - Crosses from lat. side of vessels to medial Post. Cutaneous nerve of thigh - Medial **Pop. Vein (+lesser saphenous)** then **Pop. Artery** **iii)** Popliteal LNs drain the venous distrubiton of SSV

Question 97

**Popliteal Region** 1-17

Answer 97

**1.** Semimembranosis **2.** Biceps Fem **3.** Semitendinosis **4.** adductor magnus **5.** plantaris **6.** med. Gastroc. head **7.** lat. gastroc. head **8.** IT Band **9.** Adductor Hiatus **10.** Pop. Vein **11.** Pop. Art. **12.** Tib. Nerve **13.** Common Peroneal Nerve **14.** Med. Head Gastroc. Nerve **15.** Sural Nerve **16.** Sup. Lat. Genicular Artery **17.** inf. lat. Genicular art.

Question 98

**Describe lower limb blood supply**

Answer 98

**Femoral artery -** Continuation of **external iliac artery** becoming the **femoral artery** as it passes beneath the **inguinal ligament** to enter the **femoral triangle.** Beyond the femoral triangle it descends in the **adductor canal.** **Profunda femoris artery** is a posterolateral branch of the femoral artery. **In turn** it gives off **3 main branches** - Med and lat fem circumflex arteries and then some perforating muscular branches. **Obturator artery** - arises from **internal iliac artery** and enters medial thigh through the obturator foramen. Supplies medial thigh compartment / deep gluteal muscles **Popliteal artery (discussed further below)** - gives off **3 medial** and **2 lateral genicular arteries** **Lower Leg** **Superficial femoral artery** becomes **Popliteal artery as it exits the adductor hiatus and enters popliteal fossa.** Just **inferior to the popliteal fossa it bifurcates:** **Anterior Tibial Artery -** Becomes the **dorsalis pedis artery** in the foot (passes anteriorly beneath extensor retinaculum) **Tibioperoneal trunk -**which then birfucates into the: **posterior tibial artery** passing posterior to medial malleolus **peroneal artery**

Question 99

The Leg Bones Structures 1-9 Attachments 10 - 21

Answer 99

**1.** med. tib. condyle **2.** lat. tib. condyle **3.** tib. tuberosity **4.** Med. surf. tibia **5.** fibular neck **6.** fib head **7.** Tibial Spines **8.** Popliteal surface of tibia **9.** Soleal line **10.** Semimembranosis **11.** patella tendon **12.** Bicep Fem. **13.** Soleus **14.** Popliteus **15.** Semitendin. **16.** Gracil. **17.** Sartorius **18.** Pes Anserina **19.** Med. Colat. Lig **20.** Lat. Colat. Lig **21.** IT Band

Question 100

**Lower Limb Compartments, blood supples, muscles, nerves**

Answer 100

**i) Anterior Compartment** Deep peroneal nerve/ Anterior Tibial Artery Anterior Tibialis, Extensor Hallucis Longus, Extensor Digitorum Longus, Peroneus Tertius **ii)** **Peroneal Compartment** Superficial peroneal nerve/ Peroneal Artery Peroneus Longs, Peroneus Brevis **iii) Superficial Posterior Compartment** Tibial Nerve/ Posterior TIbial Artery Gastrocnemius, Soleus, Plantaris **iv) Deep Posterior Compartment** Tibial nerve/ Posterior Tibial Artery Tibialis Posterior, Popliteus, Flexor hallucis longus, flexor digitorum longus

Question 101

Surface markings of foot Label

Answer 101

**1.** Lateral Malleolus **2.** Medial malleolus **3.** Tibialis Ant. **4.** Extensor Hallucis Longus **5.** Extensor Digitorum Longus **6.** Extensor Digitorum Brevis

Question 102

**Structures running** **- posterior to medial malleolus** **- anterior to medial malleolus**

Answer 102

**Posterior to med. malleolus:** **Ant. -\> Post (**Tom, Dick + Very Nervous Harry**)** Tib. Post Flexor Digitorum Longus Post. Tibial Art. Post. Tibial Vein Tibial Nerve Flexor Hallucis Longus Tend. **Anterior to medial malleolus :** Long saphenous vein

Question 103

Foot - Label

Answer 103

**1.** Med. Malleolus **2.** lat. malleolus **3.** Tib. Anterior **4.** Extensor hallucis longus **5.** Extensor Dig. Long. **6.** Extensor Dig. Brev. **7.** Peroneus Brev. **8.** Peroneus Tertius. **9.** Extens. Halluc. Brevis.

Question 104

Foot skeleton - label bony landpoints 1-25

Answer 104

**1.** Calcaneus **2.** Talar Dome **3.** Talar Neck **4.** talar head **5.** Navicular **6.** Cuboid **7.** Lateral Cuneiform **8.** Intermediate Cuneiform **9.** Medial Cuneiform **10.** 1st Metatarsal **11.** 3rd Metatarsal **12.** 5th Metatarsal **13.** Distal Phalanx **14.** Proximal Phalanx **15.** Distal phalanx **16.** Middle Phalanx **17.** Proximal phalanx **18.** 1st metatrsal head **19.** 1st metatarsal shaft **20.** 1st metatarsal base **21.** Ant. Tuberc. Calcaneus **22.** Substentaculum Tali **23.** Lateral process of calcaneus **24.** Medial Tubercle of Talus **25.** Lateral Tubercle of Talus

Question 105

26 - Name the fracture 27-29 - Tendons traversing groove

Answer 105

**26.** Jone's Fracture - diaphyseal 5th metatarsal **27 + 28.** Flexor Hallucis Longus **29.** Peroneus Longus

Question 106

**i) Anatomical Divisions of foot**

Answer 106

**i)** Forefoot - MTs + Phalanges Midfoot - Cuboid, Navicular + Cuneiform Bones Hindfoot - Talus + Calcaneus ( True anle joint is between talus and tib/fib. Subtalar Joint between talus + Calcaneus)

Question 107

**Foot Ankle Label**

Answer 107

**1.** Medial Malleolus **2.** Calcaenus **3.** lateral malleolus **4.** Navicular **5.** Medial Cuneiform **6.** 1st metatarsal **7.** talar dome **8.** Cuboid **9.** 5th metatarsal **10.** Achilles Tendon (common tendinous insertion of gastrocnemius, plantaris + soleus) **11.** Deltoid ligament **12.** Posterior talo-fibular ligm. **13.** Calcaneofibular ligament **14.** Anterior talo-fibular ligament. **15.** Long Plant. Ligament **16.** Peroneus Brevis

Question 108

**Structures running posterior to lateral malleolus and where they go in the foot.**

Answer 108

**Peroneus Brevis -** (From fibula) to 5th metatrsal (alongside peroneus tertius) **Peroneus Longus -** (More proximally on fibula) to 1st metatarsal

Question 109

**Describle ankle ligmanets**

Answer 109

**Medially:** **Deltoid ligament** This spans from the medial malleolus (tibia) to i) substentaculum tali ii) calcaneonavicular lig. iii) navicular tuberosity iv) medial talus **Laterally: Three Ligaments** **Anterior Talofibular Ligament (**Lateral Mal. of fib to ant. talus) **Posterior Talofibular Ligament (**Lateral Mal. of fib to post. talus) **Calcaneofibular ligament (**Lateral Mal. to Lat. Calcan.) **Syndesmotic:** **Anterior + Posterior Inferior Tibiofibular ligaments**

Question 110

**What is the angle between the femoral neck and the femoral shaft**

Answer 110

125 degrees

Question 111

**What type of bone is the patella?**

Answer 111

The patella is a sesamoid bone

Question 112

**Label A-H**

Answer 112

**A.** Vastus Medialis **B-** Sartorius **C-** Gracilis **D -** Medial Gastroc **E/F -** Semintendinosis **G -** Rectus Femoris **H -** Adductor Magnus (Hamstring Portion)

Question 113

**Attachments of cruciate ligaments**

Answer 113

**Anterior Cruciate Ligament -** Anterior tibia to lateral intercondylar notch of femur **Posterior Cruciate Ligament -** Posterior tibita to medial intercondylar notch of femur

Question 114

Label 1-12 What articulates with 7+8

Answer 114

**1.** Humerus Head **2.** Anatomical Neck **3.** Surgical Neck **4.** Greater Tub. **5.** lesser tub. **6.** Bicipital groove **7.** Capitulum (radius head) **8.** Trochlea (Ulna trochlea fossa) **9.** Coronoid Fossa **10.** Medial Epicondyle **11.** Lateral Epicondyle **12.** Olecranon fossa

Question 115

**Rotator Cuff Muscles** **Origins, insertions, innervations**

Answer 115

**Supraspinatous** - Supraspinatous fossa - Sup. fac. Greater tuberosity. *abducts* Suprascapular Nerve **Infraspinatous -** Infraspinatous Fossa - Med. Fac. greater tuberosity. *external rotate* Suprascapular nerve **Teres Minor** - Lateral border of scapula - Inf. Fac. Greater tuberosity Axillary Nerve. *external rotate* **Subscapularis** - Subscapular fossa - Lesser Tuberosity Upper + Lower Subscapular nerves. *internal rotate*

Question 116

**Muscles at coracoid process** **Muscles at intertubercular groove** **Muscles at** **greater tubercle** **Muscles at lesser tubercle**

Answer 116

**Coracoid Process:** Three Muscles * Short head of biceps* * Corachobrachialis* * Pectoralis minor* **Interubercular Groove:** Three Muscles * Latissimus Dorsi* * Pectoralis Major* * Teres Major* **Greater Tubercle:** Three Muscles * Supraspinatous* * Infraspinatous* * Teres Minor* **Lesser Tubercle:** One Muscle *Subscapularis*

Question 117

**Biceps** Innervation, attachment, insertion Which head is more lateral mid -humeral shaft

Answer 117

**Biceps** - Musculocutaneous nerve (Lat. Cord- C5-C6) Short head: Coracoid Process Long Head: supra-glenoid tubercle **both** insert onto the bicipital tuberosity (radius) **Long Head** is situated more laterally mid -humeral shaft. Generall the long head is the more bulky of the two.

Question 118

**Label 1-5** **What attaches to 5**

Answer 118

**1.** Subscapularis **2.** Supraspinatous **3.** Long Head Biceps **4.** Short head biceps **5. Coracoid Process** **Muscles -** Corachobrachialis, short head biceps, pectoralis minor **Ligaments -** Corachoclavicular, corachoacromiial, coracohumeral lig., superior transverse scapular lig.

Question 119

**Humerus** What muscles attach to **1-15** **10 -** What runs here **16.** What fracture? **17.** Which nerve traverses this structure

Answer 119

**1.** Supraspinatous **2.** Subscapularis **3.** Lat. Dorsi **4.** Pec. Major **5.** Teres Major **6.** Coracobrachialis **7.** Brachialis **8.** Brachioradialis **9.** Extensor carp. radi. long. **10.** Radial groove (radial nerve) **11.** Infraspinatus **12.** Teres Minor **13.** Triceps (Lat.) **14.** Triceps (Med.) **15.** Anconeus **16.** Supracondylar **17.** Medial epicondyle (humerus) - Ulnar nerve

Question 120

**Describe route of radial nerve + innervation**

Answer 120

Originates from posterior cord of brachial plexus. **Exits the axilla -** through triangular space **(**Lat - Humerus, Med - Long head triceps, Sup - Teres Major**)** **Before the elbow it innervates:** Triceps, Brachioradialis, anconeus, Extensor carpi radialis longus + **3 sensory branches** (posterior cutaneous nerve of arm, forearm + lateral cutaneous nerve of arm) **Then** Travels along the radial groove posteriorly before piercing intermuscular septum to enter cubital fossa at lateral epicondyle dividing into the: **superficial radial nerve** (sensory) - runs lateral to radial art. under brachioradialis into the anatomical snuffbox supplying the hand **posterior interosseus nerve** (motor) - pierces supinator distal to the radial head and runs in the extensor compartment supplying supinator + extensors

Question 121

**Brachial Plexus** - label

Answer 121

**1.** CCA **2.** SCA **3.** Axillary art. **4.** Brachial Art. **5.** Subclavian Vein **6.** Axillary Vein **7.** lat. cord **8.** post. cord **9.** med. cord. **10.** Thoracoacromial trunk **11.** Lat. Thorac. art. **12.** Axil. Nerv **13.** Musculocut. nerve **14.** Radial nerve. **15.** Median Nerve **16.**Median Nerve **17.** Ulnar nerve + medial cut. nerve of forearm **18.** Thoracodorsal nerve **19.** Long thoracic Nerve **20.** Cephalic vein **21.** External Jug. Vein

Question 122

**Antecubital Fossa** **i) Boundaries** **ii) Contents**

Answer 122

**i)** Boundaries: **Med-** Pronator Teres **Lat. -** Brachioradialis **Sup.** - line between epicondyles **ii)** Contents: Median Nerve (just medial to brachial art.) Brachial Art. Biceps Brachii Tendon Deep branch of radial nerve ( becomes post. interos. n.)

Question 123

**Antecubital Fossa**

Answer 123

**1.** Biceps Tendon **2.** Brachial Art. **3.** Med. Nerve **4.** Basilic Vein **5.** (medial epicondyle side) **6.** (lateral epicondyle side) **7.** Median. Cub. Vein **8.** Cephalic Vein **9.** Rad. Recurrent Vein **10.** Med. Cut. Nerve of forearm **11.** Ulnar nerve **12.** radial nerve **13.** Sup. Rad. Nerve **14.** Deep Rad. Nerve **15.** Post. Interosseus Nerve **16.** Lat. Cut. Nerve of forearm **17.** Brachioradialis **18.** Biceps **19.** Pronator Teres **20.** Bicipital Aponeurosis

Question 124

**Elbow Joint**

Answer 124

**1.** Humerus **2.** Lateral Epicondyle **3.** Medial epicondyle **4.** Radial Fossa **5.** Coronoid Fossa **6.** Capitulum **7.** Trochela **8.** Coronoid Process **9.** Radial Neck **10.** Radial Head **11.** Olecranon **12.** Radial Tuberosity **13.** Radial Collateral Ligament **14.** Ulna Collateral Ligament **15.** Annular Ligament **16.** Supinator Fossa **17.** Lateral Supracondylar Ridge **18.** Medial supracondylar ridge

Question 125

**Elbow Joint** **Muscles attaching 1-11**

Answer 125

**1.** Brachialis **2.** Brachioradialis **3.** Extensor Carpi Radialis Longus **4.** Pronator Teres **5.** Brachialis **6.** Flexor Digitorum **7.** Pronator Teres **8.** Supinator **9.** Flexor Digitorum Profundus **10.** Biceps **11.** Triceps

Question 126

**Forearm (Ant.)**

Answer 126

**1.** Bicep Tendon **2.** Brachial art. **3.** Median Nerve **4.** Median Cubitan Vein **5.** Cephalic Vein **6.** Bicipital aponeurosis **7.** Ulnar Art. **8.** Recurrent Radial Art. **9.** Ant. Interosseus Nerve. **10.** Common Interosseus Art. **11.** Radial ARt. **12.** Superficial Palmar Art. (Radial Art.) **13.** Ulnar art. **14.** Superficial rad. nerve ( Dorsum of hand + anatomical snuffbox) **15.** Brachioradialis **16.** Pronator Teres **17.** Flexor Carpi Radialis **18.** Flex. Dig. Profondus **19.** Palmaris longus **20.** Flexor Carpi Ulnaris

Question 127

**Forearm** **(post.)**

Answer 127

**1.** Brachioradialis **2.** Extensor carpi radialis long. **3.** Extensor carpi radialis brev. **4.** Extensor digitorum **5.** Ulna Head **6.** Extensor Carpi Ulnaris **7.** Extensor digiti minimi **8.** Abductor pollic. long **9.** Extensor pollic. long. **10.** Extensor pollic. brev. **11.** Extensor carpi radialis longus **12.** Extensor carpi radialis brevis

Question 128

**Extensor aspect Right distal forearm**

Answer 128

**1.** Extensor digitorum **2.** Extensor digiti minimi **3.** Extensor carpi ulnaris **4.** extensor pollicis longus **5.** extensor carpi radialis brevis **6.** Abductor Pollicis longus **7/8.** Extensor Pollicis Brevis **9.** Extensor pollicis Longus **10.** Extensor indices **11.** Extensor Retinaculum **12.** Radial head **13,** Interossues Membrane **14.** Anterior Interosseus Artery **15.** Radial nerve

Question 129

**Flexor Aspect Forearm**

Answer 129

**1.** Biceps Tendon 2. Brachial Art. **3.** Median Nerve **4.** Median cubital vein **5.** Bicipital Aponeurosis **6.** Radial Nerve **7 + 8.** Cephalic Vein **9.** Radial Artery **10.** Ulnar ARtery **11.** Ulnar nerve **12.** Anterior interosseus nerve (median nerve) **13.** Anterior interosseus artery **14.** Ulnar artery **15.** Brachoradialis **16.** Pronator Teres **17.** Flexor Carpi Radialis **18.** Flexor Carpi Ulnaris **19.** Palmaris Longus **20.** Pronator Quadratus **21.** Flexor Digitorum Superficialis Tendon **22.** Palmaris Longus Tendon

Question 130

**Muscles attaching to the medial epicondyle**

Answer 130

Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Digitorum Superficialis Flexor Carpi Ulnaris

Question 131

**Deep flexors of the forearm + nerve supply**

Answer 131

These arise form the volar surface of ulna +radius: Flexor Pollicis Longus Flexor Digitorum Profundus Pronator Quadratus **ALL of the flexors** are supplied by the **Median Nerve** Except **Ulnar half of Flexor Digitorum Profundus + Flexor Carpi Ulnaris -** Ulnar Nerve

Question 132

**Course of terminal brachial artery branches**

Answer 132

**Bifurcates at antecubital fossa into :** **i) Radial Artery -** Continues laterally and anteriorly. Winds laterally around the wrist passing through the anatomical snuffbox. **ii) Ulnar ARtery -** Runs deep at its origin on top of brachialis and flexor digitorum profundus. Relationship to medial nerve is important as it begins medially before crossing it to run laterally. Enters the wrist underneath transverse carpal ligament on radial side of psiform bone within guyon's canal

Question 133

**The Wrist**

Answer 133

**1.** Radial Styloid **2.** Lister's Tubercle **3.** Surface for scaphoid **4.** Surface for lunate **5.** Ulnar styloid **6.** Hook of hamate **7.** Pisiform **8.** Trapezum Ride **9.** Scaphoid Tubercle **10.** Flexor Retinaculum **11.** APB Tendon **12.** EPB Tendon **13.** ECRL Tendon **14.** ECRB Tendon **15.** EPL Tendon **16.** ED Tendon **17.** EI Tendon **18.** EDM Tendon **19.** ECU Tendon **20.** Triangular Fibrocartilage

Question 134

**Median Nerve Exam?**

Answer 134

**Look -** Thenar wasting, ulnar deviation **Sensation -** Thenar eminence (superficial median nerve) Volar aspect of index finger (median nerve) **motor -** Okay sign - FPL/FDP Palms on table and abduct thumb - APB Hold the middle phalanx and flex finger tip - FDP Hold all other fingers in extension and ask them to flex one - FDS Pronate in elbow extension - Pronator Teres **Special Tests:** Do a button - FDP/FPL Tinel's Sign - Tap Phalen's sign - flex for 60 seconds Compression test - symptoms

Question 135

**Median Nerve:** **Hand:** **Forearm:** **Nerve Roots: Course:**

Answer 135

**Hand:** Lateral Lumbricals, Opponens Pollicis Abductor pollicis Bevis, Flexor Pollicis Brevis **Forearm:** **Median Nerve Proper:** Flexor Carpi Radialis, Flexor digitorum superficialis + palmaris longus **Anterior interosseus branch:** FPL, Pronator Quadratus, Radial half of flexor digitorum profundus **Nerve Roots:** C6-T1 **Course:** Originates from Lateral and Medial Cord. Travels lateral to brachial artery in upper arm and then **crosses** to the medial side in the antecubital fossa. Leaves the antecubital fossa between two heads of pronator teres giving off the **Anterior interosseus nerve** (runs on the AIM between the FPL and FDL) **median nerve proper** (continues more superficially to pass beneath the flexor retinaculum giving off palmar cutaneous muscle prior to passing through the carpal tunnel)

Question 136

**Aorta:** **What lies anterior to the aorta at L1?**

Answer 136

**L1 -** SMA + Neck of pancreas

Question 137

**Branches of the aorta**

Answer 137

**Anterior:** T12 - Coeliac Axis (L gastric, Common Hepatic, Splenic) L1 - SMA (Inf. Pancreatoduodenal, Jej + Ileal, Ileocolic, Right Colic, Middle Colic) L3 - IMA ( Left Colic, Sigmoid, Sup. Rectal) **Posteriolateral:** T12- Inferior Phrenic L1 - Suprarenal L1-L2 - Renal Arteries L2 - Gonadal Arteries L1-L4 Four paired Lumbar arteries

Question 138

**Structures in the transpyloric plane**

Answer 138

**Midline -** Post(Ant). L1 vertebra, Aorta, SMA, Neck of Pancreas, SMV , Pylorus **Lateral -** Kidney hila, renal veins, Spleen hilum, Duodenum 2nd part, Portal vein formation (SMV + Splenic Vein meet), DJ Fexure, GB fundus, 9th costal cartilage

Question 139

**Epiploic foramen of winslow**

Answer 139

**Communication between the greater and lesser sac of the peritoneal cavity.** **Lesser Sac- Posterior** to stomach medially/ posterior to greater sac laterally **Ant** - Hepatoduodenal ligament of the lesser omentum (CBD, Common Hepatic Artery, Hepatic Portal Vein) **Post -** IVC **Sup** - Caudate lobe liver **Inf** - 1st part duodenum

Question 140

**Spleen Functions** **Structures that can be damaged in spleenctomy** **Ligaments of the spleen**

Answer 140

**Functions: FISH** **Filtration** of encapsulated organisms **Immunological** function **Storage** of platelets **haematopoeisis** in fetus **Potential to be damaged:** L Kidney, Splenic flexure, Stomach, Tail of pancreas, diaphragm **Ligaments** Gastrosplenic Ligament (greater curvature) - contain short gastric and left gastroepiploeic vessels Lienorenal Ligament (attaches to the left kidney) - contains splenic vessels and tail of pancreas

Question 141

**i) Define: portosystemic anastamosis** **ii) Sites of portosystemic anastamosis**

Answer 141

**i)** Reconnection of the portal venous system with the systemic venous system. **ii) Oesphageal -** Left Gastric/ Portal --\> Azygous (system) **Rectal -** Sup Rectal vein (port.) --\> Mid/Inf Rect Veins (system) **Retroperitoneal** **Umbilical** **Hepatic (bare area)**

Question 142

**What structure lies at the level of the 12th rib posteriorly?** **Which parts of the duodenum are retroperitoneal?** **Which abdominal organs are intraperitoneal?**

Answer 142

**12th rib posteriorly -** Superior Renal Pole **Retroperitoneal parts of duodenum** - 2nd, 3rd and 4th **Intraperitoneal Organs -** Stomach, 1st part of duodenum, Colon (caecum, transverse, sigmoid), Tail of pancreas, Liver, Uterus and ovaries

Question 143

**Differentiating between the jejenum and ileum?**

Answer 143

**Jejunum is (compared with ileum) -** Larger Thicker More Vascular Darker Red Longer vasa recta Fewer arcades

Question 144

**Differentiating between small bowel and large bowel:** **i) Radiologically** **ii) Intraoperatively**

Answer 144

**i)** Radiologically - Haustrae (large bowel - traverse 1/3 width) and Valvulae Conniventes (Small bowl - entire width) Small bowel is more central Large bowel is more circumferential **ii)** In addition - operatively: Large bowel has appendices epiploicae and taenia coli

Question 145

**Pancreas:** i) Parts ii) Function iii) Blood Supply

Answer 145

**i) Parts:** Head, Neck, Uncinate, Body, Tail **ii) Function:** Endocrine - Glucagon (alpha cells), Insulin (beta cells), Somatostatin (Delta Cells) Exocrine - Lipases, Amylase **iii) Blood Supply:** Superior Pancretoduodenal Artery (gastroduodenal) Inferior Pancreatoduodenal Artery (SMA) Splenic Artery Branches

Question 146

**Blood Supply to the stomach:** Lesser Curve Greater Curve

Answer 146

**Lesser Curve -** Right and Left Gastric Arteries **Greater Curve -** Left (Splenic Art.) and Right Gastroeipoloic Arteries (Gastroduodenal Art.)- both also supply the greater omentum

Question 147

**Kidneys:** i) Anatomical Position ii) Layers of adrenal Gland

Answer 147

i) Pelvis - L1 Between T12-L3 vertebrae ii) **Relations:** **Both:** Sup - Diaphragm, Inf - Quadratus Lumborum Lat - Transversus Abdominus Med- Psoas major **Left** Ant - Adrenal, spleen, stomach, tail of panc, small intest., colon **Right** Ant- Adrenal, liver, colon, duodenum, small intestine **ii) Adrenal Layers:** **Cortical Layers** Glomerulosa - Mineralocorticoid Fasciculata - Glucocorticoid Reticularis - Sex Hormone **Medulla** - Catecholomines

Question 148

**Topography of Peroneus Longus, Brevis + Tertius**

Answer 148

**Peroneus longus -** head of fibula -\> Medial cuneiform and base of 1st metatarsal **Peroneus Brevis -** lower 2/3 of lat fib -\> base of 5th metatarsal **peroneus tertius** - lower 1/3rd fib and IO membrane -\> base of 5th metatarsal

Question 149

**Where do you test the following:** S1 L4 Deep Peroneal Nerve Superficial peroneal Nerve Sural Nerve Tibial Nerve Saphenous Nerve

Answer 149

S1- Lateral foot L4 - Medial malleolus Deep Peroneal Nerve - First web space Superficial peroneal Nerve - Dorsum of foot (not first web space) Sural nerve - Lateral malleolus Tibial nerve - Posterior Sole of foot Saphenous nerve - Medial Aspect of foot

Question 150

**i) Vessels + nerve beneath Extensor Hallucis Longus?** **ii) Muscles involved in foot dorsiflexion?** **iii) Muscles involved in foot plantarflexion?** **iv) What do TA and TP combined cause to happen?** **v) What do PL and PB combined cause to happen?** **vi) Through what joint does ankle flexion/extension occur?** **vii) Through what joint does ankle inversion/eversion occur?**

Answer 150

**i)** Anterior Tibial Artery and Vein Deep Peroneal Nerve **ii)** AT, EHL, EDL, PT **iii)** Gastroc, Soleus, Plantaris (Superficial) FHL, FDL, Pop, TP **iv)** Foot inversion **v)** Foot eversion / Dorsiflexion **vi)** Flexion extension through - Talar-fibula/tibia joint **vi)** inversion/eversion through - Subtalar joint

Question 151

**i) Where is the true ankle joint?** **ii) Where is the subtalar joint?**

Answer 151

**i)** True ankle - synovial joint between tib/fib + talus **ii)** Subtalar joint - Between the talus and calcaneous

Question 152

Answer 152

Gluteal tuberosity (Gluteus maximus attachment)

Question 153

**Topography/action of :** **Anterior Tibialis** **Extensor hallucis Longus** **Which nerves/ arteries/ veins are in which leg compartment?**

Answer 153

**Anterior Tibialis -** Lateral tibial condyle --\> Medial cuneiform and first metatrsal *(dorsiflex/invert)* **Extensor Hallucis Longus -** Anterior fib/ IO membrane--\> Distal phalanx of hallux *(dorsiflex foot/hallucis + invert foot)* **Anterior Compartment -** ATA, ATV, Deep peroneal n. **Lateral Compartment -** Superficial peroneal nerve **Deep posterior compartment -** PTA, PTV, Tibial Nerve, Peroneal Artery

Question 154

**Leg muscles attaching to the medial cuneiform?**

Answer 154

**Attaching to the medial cuneiform** - PL, TA, TP

Question 155

**nerve supplying sensation to the :** Medial Leg Dorsum of Foot First web space

Answer 155

Medial leg - **Saphenous** Dorsum of foot - **Superficial peroneal Nerve** First web space - **Deep peroneal nerve**

Question 156

**Label and describe**

Answer 156

**Pop Art.** --\> Divides into **AT** and **TP Trunk** **AT** travels along the IO membrane in the anterior compartment becoming the **DPA** when it crosses between med/lat malleoli **TP Trunk** divides 2.5cm after the initial bifurcation into the **PTA** and the **PA.** **PTA -** in posterior compartment runs behind medial malleolus **PA -** in posterior compartment between Tib. Post + FHL

Question 157

**i)** **Gross anatomical route of greater saphenous vein** **i) "" of the lesser saphenous vein**

Answer 157

**i)** Originates from dorsal venous arch of foot Passes anterior to medial malleolus Posterior to medial epicondyle of femur Enters the femoral triangle and joins the femoral vein at the SFJ **ii)** Originates from doral venous arch of foot. Posterior to lateral malleolus Runs posteriorly with the sural nerve. Joins popliteal vein in popliteal fossa

Question 158

**Route/Function of vas deferens**

Answer 158

From the epididymis through the **inguinal** **canal** to **Pelvic side wall** to **Ejaculatory Ducts** It **functions** to transport sperm from the testes to the urethra

Question 159

**What is the structure arrowed?** **What is function?**

Answer 159

**Seminal Vesicle** Outpouching of the vas deferens ampulla responsible for producing a fair volume of seminal fluid

Question 160

**Bladder:** i) Angle of ureteric entry ii) Relations iii) What is the pouch of douglas? iv) Arterial Supply / Venous Drainage v) Muscular 'arrangement' of the baldder? vi) Inneration

Answer 160

i) Ureter enters bladder obliquely ii) **Relations:** **Ant -** Pubic Symphysis **Post -** Recto-vesic pouch/denonvillier's Fascia/ Rectum/ prostate - Male, Vesico-uterine pouch/Vagina - Female iii) Pouch of douglas - Rectouterine pouch iv) **Arterial Supply - (Internal Iliac artery via:)** Sup. Vesicular Art Mid. Vesicular Art Inf. Vesicular Art. **(Prostatovesical in men) Vesical Venous Plexus --\> Internal Iliac veins** v) **Detrussor muscle is arranged into :** Longitudinal, circular + spiral bundles vi) **Innervation:** **PNS (encourages micturition) -** Pelvic Splanchnic Nerves + Inf. Hypogastric Plexus (S2-S4) **SNS (prevents micturition) -** Hypogastric plexus **Pudendal Nerve (s2-s4) -** External Urethral Sphincter

Question 161

**Ureters:** i) Arterial supply​ ii) Normal ureteric narrowings + significance iii) How is pain from the ureter transmitted?

Answer 161

i) Divided into 3: **Upper 1/3rd -** Renal art., Aortic branches, Gonadal Branches **Middle 1/3rd** - Common iliac, Gonadal **Lower 1/3rd -** Common Iliac/ Internal Iliac (Partic. Superior vesicular artery +uterine art.) ii) **Significance -** Stones most often get stuck here VUJ, As they traverse the pelvic rim, PUJ iii) **Upper + middle -** T11- L2 **Distal -** Genitofemoral + Ilioinguinal nerves

Question 162

**Where can the different brachial plexus components be found?**

Answer 162

**Roots-** Between anterior and middle scalene **Trunks -** Base of posterior neck triangle **Divisions -** Posterior to middle third clavicle **Cords -** Surround the 2nd part axillary artery **Branches -** Around the 3rd part axillary artery

Question 163

**Long thoracic nerve:** i) Roots ii) Supplies **Roots of the:** iii) Medial cutaneous nerve of the forearm iv) Medial cutaneous nerve of the arm v) Thoracodrosal Nerve vi) Medial Pectoral Nerve vii) Lateral pectoral Nerve

Answer 163

i) Roots - C5-7 ii )Serratus Anterior iii) **C8** iv) **T1** v) **C6-8 from posterior cord** (Latissimus Dorsi) vi) **C8-T1 from medial cord** (Pec Maj + Min) vii) **C5 - C7 from lateral cord** (Pec Maj )

Question 164

**Klumpke's Palsy** i) Mechanism of cause ii) Features **Erb's Palsy**

Answer 164

**KP** i) Abduction / tractional injury ii) Lower roots effected so : Intrinsic handle muscles are dennervated Unopposed action of flexors/extensors of forearm -\> Claw hand (**flexed IP joints** , **extended MCP joints)** **EP** iii) Donward force from humeral head / shoulder. iv) **Waiter's tip-** Upper nerve roots effected (C5-C6): Loss of - **Shoulder abduction, External rotation, Elbow flexion, supination** Producing - Adducted, internal rotated shoulder. Extended and pronated forearm

Question 165

**Ulnar nerve compression at wrist - features** **More or less pronounced compared to more proximal lesion?**

Answer 165

**Senosry -** medial 1.5 fingers **Motor -** intrinsic muscle weakness. Manifests as clawing of 4th and 5th digits **The clawing** is more pronounced at this level as FDP is spared.

Question 166

**Flexor Retinaculum -** **i) attachment points** **ii) Contents of carpal tunneL)** **iii) what supplies senation to thenar eminence**

Answer 166

**i)** **Attaches proximally -** Scaphoid (laterally) Psiform (medially) **Distally -** Trapezoid (laterally) Hamate (medially) **ii)** 1 neve + 10 tendons **Median nerve** 4x FDS, 4x FDP, 1 x FPL, 1 x FCR **iii)** Thenar eminence sensation supplied by - Palmar cutaneous nerve which is given off before the tunnel

Question 167

**10 non terminal branches of brachial plexus** **Roots, Where they come from, What they innervate**

Answer 167

**Long Thoracic Nerve -** C5-C7 **Roots.** Ser. Ant. **Dorsal Scapular Nerve-** C5 **Root.** Rhomb/ Lev. Scap. **Nerve to Subclavius -** C5-C6. **Roots.** Subclavius **Suprascapular Nerve -** C5-C6. **Sup. Trunk.** Supraspin/Infraspin. **Upper Subscapular Nerve -** C5/C6. **Post. Cord.** Subscapular. **Lower Susbcapular Nerve-** C5/ C6. **Post. Cord.** Subscapular. + Teres Major **Medial cutaneous nerve of forearm**- C8. **Medial Cord.** **Medial cutaneous nerve of arm** - T1. **Medial Cord.** **Medial Pectoral nerve -** C8-T1. **Medial Cord.** Pec Maj+ Min **Lateral Pectoral Nerve -** C5-C7. **lat. Cord.** Pec Maj. **Thoracodorsal nerve -** C5-C7. **Post. Cord.** Latisimmus Dorsi

Question 168

**Superior Limit of the lung pleura?** **innervation of the parietal pleura** **Innervation of the visceral pleura**

Answer 168

Pleura Projects 2.5cm above the middle of the clavicle **Parietal Pleura** is innervated by intercostal nerves/ phrenic nerve **Visceral pleura** is innervated by the pulmonary plexus

Question 169

**What features does a typical rib comprise of?** **What makes certain ribs different?**

Answer 169

**2 x demifacet -** Articulates with vertebra above and below **Tubercle -** Articulates with transverse process of vertebra **Subcostal groove -** Containing intercostal bundle (SUperiorly - vein, artery, nerve - inferiorly) **Atypical Ribs;** **1.** Has a single facet and an extra tubercle (Scalene tubercle) **10-12.** Have a single facet (articulate with corresponding vertebra alone) **11-12.** Have no tubercle

Question 170

**The breast** **i) Extent** **ii) Vasculature** **iii) Lymphatic Drainage**

Answer 170

i) Extends from the sternal edge to mid-axillary line from T2-T6 ii) **Mainly** lateral thoracic artery. Also - Internal thoracic artery, posterior intercostals + thoracoacromial artery iii) **APICAL -** Anterior/pectoral nodes, Poterior/subscapular, infraclavicular, central, apical, lateral/brachial **Medially -** internal thoracic lymph nodes **Superficially -** Contralateral breast + abdominal wall

Question 171

**Superior Mesenteric Artery:** i) Arises from? ii) Immediately behind? iii) relation to duodenum?

Answer 171

i) arises from L1 abdominal aorta ii) immediately behind pancreatic body iii) Passes anteriot ti 3rd part duodenum and uncinate process of pancreas.

Question 172

**Layers of the abdomen at the level of appendix**

Answer 172

Skin Camper's Fascia Scarpa's Fascia External Oblique Aponeurosis Internal Oblique Muscle Transversus Abdominis Transversalis Fascia Extraperitoneal Fat Peritoneum

Question 173

**Appendix:** **i) Positions** **ii) how to identify at surgery**

Answer 173

**i)** Retrocaecal, Pelvic, Subcaecal, Postileal, Preileal **ii)** Three taenia coli converge at the caecum and form longitudinal muscle layer. Where they converge you can find the appendix

Question 174

**Rectum:** **i) Vasculature** **ii) Innervation** **iii) ?Position** **iv) Most common sites of colonic cancer?**

Answer 174

**i)** SMA - Inferior Mesenteric MMA - Internal Iliac IMA - Internal pudendal artery **ii)** Innervation: **Parasympathetic -** S2-S4 (nervi erigentes). Fullness sensation + relaxation of **IAS** **Sympathetic -** Superior hypogastric plexus + lumbar splanchnic nerves. Pain + contraction of **IAS** **iii)** **Retroperitoneal** 1st third - Covered by peritoneum anteriorly/laterally 2nd third - Covered by peritoneum laterlly Final third - **Extraperitoneal** **iv)** Sigmoid then rectal

Question 175

**Differentiating between occulomotor nerve palsy and horner's syndrome?**

Answer 175

**CN III Palsy -** Pupil down and out - Pupil dilated (Unopposed sympathetic activity as CNIII carries PNS fibers to the sphincter pupillae). - Ptosis (Dual innervation CNIII and sympathetic) **Horner's Syndrome** - - Ptosis - Pupil Constricted (loss of sympathetic nerve) (meosis) - Enopthalmos (and anhydrosis)

Question 176

**Extraocular Muscle Innervation**

Answer 176

**CN III -** Sup. Rectus, Med. Rectus. Inf. Rectus, Inferior Oblique, Levator Palpebrae Superioris **CNIV -** Superior Oblique **CN VI** - Lateral Rectus

Question 178

**Components of:** **i) Medial Longitudinal Arch** **ii) Lateral Longitudinal Arch** **iii) Transverse Arch**

Answer 178

**i) Medial Longitudinal Arch** **Bones:** Calcaneum, Talus, Navicular, 3 cuneiforms, medial 3 metatrsals **Ligaments -** Interosseus/ spring **Muscles -** FHL, FDL, FDB, TA, TP **ii) Lateral Longitudinal Arch** **Bones:** Calcaneum, Cuboid, lateral 2 metatarsals **Ligaments:** Long and short plantar ligaments **Muscles;** Peroneus Longus, FDL, FDB **iii) Transverse Arch** **Bones -** Base of all metatarsals **Ligaments -** Interosseus **Muscles -** Peroneus Longus,

Question 179

**Describe the four muscle layers of the foot**

Answer 179

**Deep:** 1. Interossei, PL + TP tendons 2. FHB, AH, FDMinimi 3. Quadratus PLantae, lumbricals. FHL, FDL tendons 4. Abductor Hallucis, Abductor Digiti Minimi, FDB **Most superficial**

Question 180

**What is the arrowed structure?**

Answer 180

Pronator Teres

Question 181

**i) Flexors of the elbow joint** **ii) Boundaries of antecubital fossa** **iii) Contents of antecubital fossa**

Answer 181

**i) 3Bs** Biceps, Brachialis, Brachioradialis **ii) Lateral -** Brachioradialis **Medial-** Pronator Teres **Superior-** Imaginary line through the humeral epicondyles **Superficial -** Bicipital Aponeurosis **Deep -** Brachialis/Supinator **iii) Antecubital fossa -** (Medial to biceps tendon) - brachial art., median nerve, basilic vein. Medial cubitan vein. Brach Art. -\> Radial + Ulna art.

Question 182

**Compartments of the**

Question 183

**What is in the:** **i) Anterior Superficial Forearm Compartment** **ii) Anterior Deep Forerarm Compartment** **iii) Posterior Superficial Forearm Compartment** **iv) Posterior Deep Forearm Compartment**

Answer 183

**i) Anterior Superficial Forearm** Pronator Teres, FCR, FDS, PL, FCU **ii) Anterior Deep Forearm** FPL, FDP, Pronator Quadratus **iii) Posterior Superficial Forearm** Brachoradialis, ECRLong, ECRBrev, EDigit, EDMinim, ECUln, Anconeus **iv) Posterior Deep Forearm** Supinator, EPolB, Ext.Ind., AbdPolL, EPolL

Question 184

**Ulnar Nerve Course**

Answer 184

Originates from the medial cord of the brachial plexus. - Travels post. to medial epicondyle of humerus - Passes between two heads of FCU to enter anterior compartment of the forearm. - Anters the the hand alongside Ulnar Art. Through Guyon's Canal

Question 185

**Compare FDP to FDS**

Answer 185

**FDP** attached to distal phalanges **FDS** attached to middle phalanges (splits to allow FDP tendon to pass through)

Question 186

**i) What is the conjoint tendon?** **ii) Fibre arrangement of the external oblique and internal oblique (Innervation)** **iii) What is the sensory innervation of the teste (dermatome)**

Answer 186

**i)** Thickening of the transversus abdominus as it attaches to the crest of the pubis. **ii)** External Oblique - Inferiorly + Anteriorly (hands in pockets). *Lower 6 intercostal nerves + Subcostal nerve* Internal Oblique - Inferiorly + Posteriorly ( hands in contralateral pocket). *lower intercostal, iliohypogastric, ilioinguinal* **iii)** T10. Therefore pathology from ureters (also T10) Can radiate to testes. Furthermore testes pathology can radiate to umbilicus

Question 188

Which structures are enclosed in the femoral sheath?

Answer 188

Femoral Artery + Vein (Not the femoral nerve)

Question 189

**Hunter's Canal:** **i) Borders** **ii) Contents** **iii) Where is the adductor hiatus?**

Answer 189

**i)** anterolaterally - Vastus medialis anteromedially - sarotorius posteriorly - adductor longus + magnus **ii)** SFA, Femoral Vein, Saphenous Nerve, Nerve to vastus medialis **iii)** 2/3 along an imaginary line between ASIS and Adductor Tubercel

Question 190

**Boundaries of the carpal tunnel:** i) name them ii) surface marking of flexor retinaculum iii) Contents

Answer 190

i) **Carpal bones** form the floor **Flexor retinaculum** form the roof ii) The distal wrist crease is the surface marking for the proximal flexor retinaculum iii) 10 Tendons - 4 FDP 4 FDS 1 FPL 1 FCR Median Nerve

Question 191

**Boundaries of the anatomical snuffbox:** **i) Name them** **ii) Contents** **iii) Blood supply to the scaphoid bone**

Answer 191

i) Lateral(radial) - Abductor Pollicis Longus/ Extensor Pollicis Brevis Medial (Ulna) - Extensor Pollicis Longus Floor - Scaphoid Bone /Trapezium / Base of 1st Metacarpal/ Radial Styloid Process **ii)** Contents - Radial Art., Radial N., Cephalic Vein **iii)** Predominantly from the dorsal/distal ridge via branch of the radial art. The rest of the bone is supplied by retrograde flow

Question 192

**Hand Muscle Innervation:** **I) What does the median nerve innervate?** **ii) Discriminatory movements for ulnar nerve function and median nerve function?** **iii) What do lumbricals do?** **iv) What do interosseis do?** **v) What prevents bow stringing of the flexor digitorum tendons?**

Answer 192

**i)** Median Nerve in the hand innervates: Lateral Lumbricals Opponens Pollicis Abductor Pollicis Brevis Flexor Pollicis Brevis **ii)** **Ulnar Nerve -** Finger Abduction (resisted) **Median Nerve** - Thumb Opposition (resisted) **iii)** Lumbricals - Flex MCP and Extend IPs **iv)** palmar interossei (4) - Adduct digits dorsal interossei (5) - abduct digits **v)** Bowstringing is prevent through a series of ligamentous pulleys: Flexor Retinaculum Cruciate and annular ligaments

Question 193

**Describe the compartments of the extensor retinaculum of the wrist**

Answer 193

**Principally there are 6 compartments:(rad to uln)** 1. Extensor Pollicis Brevis + Abductor Pol. Long 2. ECR L+ B 3. Extensor Pollicis Longus 4. Extensor Indicis Proprious, Extensor Digitorum Communis 5. Extensor Digiti Minimi 6. Extenor Carpi Ulnaris

Question 194

**What parts of the heart form the various anatomical borders?**

Answer 194

**Apex -** Left Ventricle **Right -** Right Atrium **Left -** Left Ventricle **Inferior -** Right + Left Ventricle **Front -** Right Ventricle **Back -** Left Atrium

Question 195

**Describe Pericardial Layers**

Answer 195

**Three Layers:** Outer **Fibrous** Pericardium - Attaches to central tendon of diaphragm + great vessels Inner Serous Pericardium is divided into: * *Parietal** Serous * *Visceral** Serous

Question 196

**Cardiac Arteries:** **i) LCA / RCA run in the?** **ii) Left Anterior Descending also known as the ? runs where?** **iii) What is the name of the artery which is a continuation of LAD** **iv) From where do the LCA / RCA originate?**

Answer 196

**i)** Atrioventricular Sulcus **ii)** Anterior Interventricular Artery runs in the **anterior interventricular groove** **iii)** After giving off the LAD the LCA continues as the L Circumflex Artery iv) **LCA** - L Posterior Aortic Sinus (R Post. has no artery originating from it) **RCA -** Anterior Aortic Sinus

Question 197

**Sinoatrial Node:** i) Where is it? ii) Blood Supply?

Answer 197

i) It is on the crista terminalis of the right atrium ii) Bimodal population distribution. 60% - RCA 40% - LCA

Question 198

**Describe venous drainage of heart**

Answer 198

**Coronary Sinus** is formed from the **great cardiac vein + Left Marginal vein** over the left ventricle. **Coronary Sinus** continues on receiving tributaries (**posterior vein of LV, middle cardiac vein, small cardiac vein)** and eventually drains into the **right atrium between the tricuspid valve and IVC.** Anterior Cardiac Veins drain directly into the right atrium

Question 199

**Muscles attaching to the treater tuberosity of the humerus?** **What does the radial nerve run inbetween?** **What lies in the intertubercular groove of the humerus?** **Origin of biceps long head? Its attachment?** **Origin of coracobrachialis? What else comes from here?**

Answer 199

**Muscles attaching to the greater tuberosity** 1. Supraspinatous 2. Infraspinatous 3. Teres Minor **Radial Nerve runs in the spiral groove** in between the **medial** and **lateral heads** of the triceps The biceps long head - lies in the **intertubercular groove** of the humerus. - originates from the **supraglenopid tubercle** **-** attaches (alongside the short head biceps in a combined tendon) at the radial tuberosity (of the radius) + the bicipital aponeurosis **Describe relativity of the pectoralis major, teres major and latissimus dorsi attachments on the humerus:** - Pec major attaches laterally on the intertubercular groove. - Latissimus Dorsi in the middle - Teres Major medially to latisimmius dorsi **Coracoiod Process Origin:** - Short Head Biceps Brachii - Croacobrachialis

Question 200

**Attachment points of the ACL**

Answer 200

Medial surface of intercondylar area of the tibia --\> Lateral femoral condyle **Runs in a posterolateral direction from the intercondylar area of the tibia**

Question 202

**Arterial Supply to the knee?**

Answer 202

**6 Arteries** **Superior -** Medial and lateral **genicular arteries** **Inferior** - Medial and lateral **genicular arteries** **Descending Genicular Arteries** **Recurrent Anterior Tibial Arteries**

Question 203

**What does vastus medialis do that is different to the other quadriceps muscles?**

Answer 203

Stabilises the patellar and knee joint in gait. **All quadriceps muscles:** Flex the hip joint Extend the knee joint

Question 204

**What do the posterior divisions of L2 - 4 colaesce to form?**

Answer 204

Obturator Nerve (Posterior to L2-L4) Femoral Nerve ( Anterior to L2-L4)

Question 205

**Key differencs between the semitendinosis and the semimemranosis?**

Answer 205

**Origin -** Ischial Tuberosity **Semitendinosis -** Large tendinous insertion **Semimmebranosis -** Most medial hamstring muscle Membrane like insertion forming an aponeurosis

Question 206

**What are the surface markings:** **i) of the liver?** **ii) of the gallbladder?**

Answer 206

**i) The Liver** **Superior Right** - T4 Costal Cartilage **Superior Left** - Mid Clavicular line, T5 Costal cartilage **Inferior** - T10 Costal Cartilage, Mid Axillary Line **ii) The Gallbladder** - In the Transpyloric plane - In between the 9th costal cartilage and the lateral border of rectus muscle

Question 207

**i) Borders of Calot's Triangle?** ## Footnote **Ii )Contents ?** **iii) Define Courvosier's Law** **iv) What are kehr's and boas sign**

Answer 207

**i)** Superior - Inferior liver edge Medially - Common hepatic Duct Laterally - Cystic Duct **ii)** Contents - Cystic Artery + LN of Lund **iii) Courvosier's Law -** When there is obstructive jaundice and a palpable gallbladder, gallstones are not the cause **iv ) Referred Gallbladder Pain :** **Kehr's - Right shoulder Tip** **Boas' Sign - Scapula**

Question 208

**under surface of the liver**

Answer 208

**1.** Right Lobe **2.** Left Lobe **3.** Quadrate lobe **4.** Round ligament of liver **5.** Falciform ligament of liver **6.** Caudate Lobe **7.** IVC **8.** CBD **9.** Hep. A **10.** Portal Vein **11.** Cystic Duct **12.** Hepatic Duct **13.** Gallbladder

Question 209

**Surface Anatomy of the lungs and pleura** **i) Surface marking for oblique fissure** **ii) Surface marking for horizontal fissure** **Level of:** **iii) Suprasternal notch** **iv) Angle of louis** **v) Xiphisternum**

Answer 209

**Pleura** **Superiorly** - 2.5 cm above the mid point of the medial clavicle ---\> Coming down the R+L pleura meet in the midline at the **2nd rib** **Parasternally -** Right goes down to the 6th rib. Left goes down to the **4th rib** (space for the heart). **Going inferiorly** - **8th -** Mid clavicular line **10th -** Mid axillary line **12th** - posterior chest **(subtract two from each of these to get the corresponding lung level)** **i) Oblique fissure -** From T3 vertebra to 6th rib anteriorly **ii) Horizontal fisure (R Only) -** 4th costal cartilage to fifth rib in mid axillary line **iii)** T2 **iv)** T4/T5 **v)** T9

Question 210

**Describe the bronchopulmonary arrangements of respective lungs:**

Answer 210

Bronchopulmonary segment: Bronchus, Artery, vein and lymphatics **Right:** **10 Bronchopulmonary segments:** **Upper Lobe - 3** **Middle Lobe - 2** **Lower lobe - 5** **Left:** **9/10 Bronchopulmonary segments** **Upper Lobe - 4/5** **Lower lobe - 5**

Question 211

**Which Structures are present in the lung hilum?**

Answer 211

**5:** Primary Bronchus Pulmonary Artery / Vein Bronchial Artery / Vein Lymph Nodes Autonomic Nerves

Question 212

**i) Which layers make up the deep cervical fascia?** **ii) Contents of each of these fascia**

Answer 212

**i)** Carotid Sheath, Prevertebral, Pretracheal, Investing layer of deep cervical fascia **ii) Carotid Sheath -** CCA, IJV, CN X, Lymph Nodes (in the wall of the sheath is ansa cervicalis) **Prevertebral -** Vertebral Column, Deep back muscles, prevertebral msucles (Levator scapulae, Splenius Capitis), scalene muscles, **and subclavian artery + brachial plexus in lower neck region** **Pretracheal -** Thyroid gland, Oesophagus, Trachea, infrahyoid muscles **Investing Layer -** Surrounds all of the deep cervical fascial compartments

Question 213

**Where does CN XI cross the Posterior Triangle?**

Answer 213

1/3 of the way down SCM --\> 1/3 of the way up Trapezius

Question 214

**Oesophagus:** **i) Blood Supply/Lymphatic** **ii) Causes of physiological narrowings** **iii) Origin of oesophageus** **iv) Smooth/ Skeletal muscle in the oesophagus**

Answer 214

**i)** **1st Third-** Inferior Thyroid Artery Deep Cervical LNs **2nd Third -** Aorta Para Aortic/ Pre arotic **3rd Third -** Left Gastric Artery/ Inferior Phrenic Coeilac nodes **ii)** * *A** rch of aorta * *B** ronchus (Left) * *C** Left Atrium * *D** iaphragm However the most norrow part is at the cricopharyngeus sphincter **iii)** Originates at C6 level at the cricoid cartilage **iv)** Upper third has skeletal muscle under voluntary control to assist swallowing

Question 215

**Describe the Lower Oesophageal Sphincter**

Answer 215

**A functional Sphincter** **-** The high pressure zone is maintained by several factors including: i) Acute angle of entry through diaphragm (Angle of His) ii) Phreno-oesophageal ligamnet encircling the GOJ iii) Mucosal folds found at the GOJ

Question 216

**Types of dipahragmatic hernia**

Answer 216

**i) Hiatus (Sliding or rolling** **ii) Bogdalek** **iii) Morgagni** **iv) Tramatic/ Iatrogenic**

Question 217

**Define : Metaplasia**

Answer 217

Reversible Replacement of one differentiated cell type with another differentiated cell type.

Question 218

**Retroperitoneal vasculature:** **i) Which level do they enter the IVC?** **ii) Anterior or Posterior to Renal arteries at hilum?** **iii) Which vessels cross the ureter?** **iv) Where does the IVC originate and what lies anterior to it at this point?** **v) Aorta becomes anterior or posterior in relation to the IVC distally?**

Answer 218

**i)** L1 **ii)** Anterior to the renal arteries. The most posterior structure at the hilum are the ureters **iii)** Gonadal Art+ Vein Left ureter- Left Colic Right Ureter- Right Colic + Ileocolic Uterine Art. **iv)** Originates at L5 (Joining of CIVs) and is crossed by the right CIA **v)** Proximally - the aorta is posterior and on the left of the IVC. Distally - distal aorta is anterior to and on the left of the IVC

Question 219

**Retroperitoneal Organs**

Answer 219

Kidneys/ Adrenals Ureters Bladder Pancreas (not tip or tail) Duodenum (not 1st part) Ascending + Descending Colon IVC Aorta Vagina Rectum

Question 220

**Parotid Gland:** **i) Surface Markings** **ii) Innervation** **iii) Structures passing through: Superficial to deep** **iv) Causes of parotid gland swelling?** **v) Which muscle does the Zygomatic Branch of CNVII Supply?**

Answer 220

**i) Superior-** From tragus of ear forward to zygomatic arch. **Medial -** From zygomatic arch arches down towards angle of mandible **Posterior / Lateral -** Ascends wrapped around angle of mandible. **ii) Innervated by Auriculotemporal Nerve (V3)** --\> The branches orginiate from CN IX (PNS) **iii) SUP:** CNVII, Retromandibular Vein (formed from max. vein + sup. temp. vein), External Carotid. **iv) Mechanical -** Stones, Obstructed Duct**.** **Infection**- Mumps, bacteria, TB. **Neoplasm.** **Autoimmune-** Sjogrens, SLE, Sarcoid. **Drug -** Antipsychotics **v)** CNVII Zyg. supplies Orbicularis Oculi

Question 221

**Shoulder:** **i) Ligament between Coracoid Process + Clavicle?** **ii) Tendon responsible for Supraspinatous Impingement?** **iii) What type of joint is the sternoclavicular joint?** **iv) Nerve supply of rhomboideus** **v) Action of Serratus Anterior**

Answer 221

i) **Coracoclavicular Ligament -** Has two portions: Conoid and Trapezoid ligaments **ii)** **Coracoacromial ligament** **iii) Atypical Synovial -** has a disc but also partly resembles ball and socket **iv) Rhomboids -** Dorsal Scapular Nerve ( C5 Nerve Root) **v) Serratus anterior** - Lateral rotation/ protraction of scapula (C5-C7 Roots)

Question 222

**Axillary Artery:** **i) Boundaries** **ii) Branches**

Answer 222

**i)** **Proximal** - Lateral border of first rib. **Distal** - Inferior border of teres major **ii) Proximal to pec minor -** Sup. Thoracic **Posterior to pec minor -** Thoracoacromial, Lat. Thoracic **Distal to pec minor -** Subscapular., P+A circumflex

Question 223

**Boundaries/ Transmits:** **i) Quadrangular Space** **ii) Triangular Space** **iii) Triangular Interval**

Answer 223

**i)** **Quadrangular Space:** Sup- Teres Minor/ Subscapularis Inf- Teres Maj. Med- Long Head Triceps Lat - Humerus Transmits - Axillary N. Post. Circumfl. **ii)** **Triangular Space:** Lateral- Long head Triceps Sup. - Teres Minor Inf. - Teres Major Transmits- Circumflex Scapular Art. **iii) Triangular Interval:** Sup - teres major Lateral- Lateral head tric. Medial- Long head tricep Transmits - Rad. Nerve + Profundi Brachii Art.

Question 224

**What attaches to:** **i) Coracoid Process** **ii) Supraglenoid Tubercle** **iii) Infraglenoid Tubercle** **iv) Acromium** **v) Greater Tuberosity** **vi) Lesser Tuberosity** **(of the shoulder)**

Answer 224

i) **Coracoid** **Process** (of the scapula palpable beneath the clavicle) - Short head biceps, Pec Minor, Coracobrachialis. **ii)** **Supraglenoid Tubercle** - Long head biceps **iii) Infraglenoid tubercle -** Long head triceps **iv) Acromion** (Continuation of the spine of the scapula) - Deltoid + Trapezius **v) Greater Tuberosity -** Supraspinatous, Infraspinatous, Teres Minor **vi)** **Lesser Tuberosity -** Subscapularis

Question 225

**Where does serratus anterior attach?**

Answer 225

**Origin -** Attaches to the **scalene tubercle** of the first rib - which is medially located on the posterior upper sruface **and** **1st - 9th** **Ribs** via series of slips **Insertion -** **Medial border of scapula** (Superior / Middle / Inferior insertions)

Question 226

**i)What is it?** **ii) How does it enter the abdomen?** **iii) How do sympathetic nerves leave the trunk**

Answer 226

**i) Sympathetic Trunk:** ii) Descends through carotid canal forming a plexus on ICA passing anterior to the first rib. Descends just lateral to the vertebral bodies and passes behind median arcuate ligament to enter abdominal cavity. iii) Formation of plexuses surrounding arteries **or** hitching on spinal nerves

Question 227

**Thoracic Duct :** **i) Lies anterior to?** **ii) Drains into the?** **iii) What else drains lymph**

Answer 227

**i)** Thoracic Duct lies anterior to the sympathetic trunk on the left side. Passes into the thorax at the t12 aortic hiatus **ii)** It drains lymph beneath the diaphragm **and** the left thorax (L Jugular, Mediastinal and subclavian trunks). **Drains** into the **L Brachiocephalic vein** **iii)** The **right** **thorax** has an independent route of drainage int the **R brachiocephalic vein**

Question 228

**i) Describe the intercostal neurovascular bundle?** **ii) Arterial supply to the posterior intercostal spaces?** **iii) Arterial supply to the anterior intercsotal spaces?**

Answer 228

i) Superior to Inferior: Vein, Artery Nerve On the underside of the superior rib inbetween the innermost and inner intercostal muscles **ii)** 1st two - By the costocervical artery of the subclavian artery Rest by the intercostal arteries (segmental) **iii)** Internal Thoracic artery of the subclavian artery (supplies breasts too)

Question 229

**i) Innervation of Anterior body of digastric muscle?** **ii) How is the submandibular gland related to thy mylohyoid muscle?** **iii) Describe route of Wharton's Duct? what nerves are closely related to it?** **iv) Nerve at greatest risk during submandibular gland surgery?**

Answer 229

**i) Mylohyoid nerve -** Which is a branch of the inferior alveolar nerve (V3) **ii)** Surrounds the muscle. Bulk is superficial to the muscle but there is a smaller portion deep to it **iii) Wharton's Duct** - Lies in between Mylohyoid (superficial to it) and Hypoglossus (Deep to it) and opens either side of the lingual frenulum Lingual nerve and hypoglossal nerve are in close proximity. **iv)** Marginal Mandibular Nerve - incision 2.5cm inferior to the mandible

Question 230

**i) Cardiac Surface Markings** **ii) Anterior Surface of Heart** **iii) Possterior Surface of Heart** **Chest X Ray Cardiac Anatomy** **iv) Right Lower Parasternal** **v) Left Heart Border**

Answer 230

**i) Superior -** 3rd Rib at Right Parasternal/ 2nd Rib at Left Parasternal **Inferior -** 5th ICS Left Mid Clavicular Line/ 6th ICS Right Parasternal **ii) Anterior -** ​Right Atrium + Right Ventricle **iii)** **Posterior -** Left Atrium **iv) Right Atrium -** Right Border of cardiac sillouhette **v) Left Ventricle -** Left border of cardiac sillouhette

Question 231

**Surface Markings of the i) pleura** **ii) Oblique Fisure** **iii) Horizontal Fissure**

Answer 231

**i) Superior** - 2.5cm above medial third of clavicle Meet at **sternum** --\> then **4th rib** seperate **8th rib** - Mid - Clavicular **10th rib** - Mid - Axillary **12th rib** - Posterior **Note** - **R side** of pleura descends 6th parasternally before moving off midline / whereas **L Side** of pleura descends 4th parasternally before moving off midline **ii) Oblique Fissure:** 3rd thoracic spine posteriorly --\> 6th Costocondral Junction ANteriorly **iii)** **Horizontal Fissure:** Oblique Fissure in mid axillary line --\> Fourth Costal Cartilage (only on right)

Question 232

**Which Muscle:** **i) Opens the vocal cords** **ii) Close Vocal Cords** **iii) Reduce Tension in the vocal cords** **iv) Increase tension in the vocal cords** **v) Name the strap muscles ( again ) and their innervation**

Answer 232

i) **Posterior Cricoarytenoid -** Opens the vocal cords **ii) Lateral Cricoarytenoid -** Close the vocal cords **iii) Thyroarytenoids -** Reduce tension in vocal cord **iv)** **cricothyroids -** Increase tension in vocal cord **v)** Strap Muscles function to depress hyoid and larynx: **Ansa Cervicalis (C1-C3 originating from cervical plexus. Content of the carotid sheath) -** Sternothyroid, Sternohyoid, Omohyoid **C1 -** Thyrohyoid

Question 233

**Nerve supply to muscles of:** **i) Larynx** **ii) Pharynx** **iii) Tongue** **iv) Mastication**

Answer 233

Question 234

**Describe the sensory and motor supply to the larynx**

Answer 234

**Sensory:** **Internal Laryngeal Nerve -** Sensation above vocal Cords **Recurrent Laryngeal Nerve -** Sensation below vocal cords **Motor:** **External Laryngeal Nerve-** Cricothyroid **Recurrent Laryngeal Nerve -** Everything else

Question 235

**Level of the :** **Hyoid Bone** **Thyroid Cartilage** **Cricoid Cartilage**

Answer 235

**Hyoid Bone -** C3 **Thyroid Cartilage -** C4 **Cricoid Cartilage -** C6 Note the cervical levels also correspond with which pharyngeal arch they originate from.

Question 236

**Parathyroid Glands:** **i) Where are they found?** **ii) Which pharyngeal arches do they come from?** **iii) Blood Supply?**

Answer 236

**i)** They are found posterior to the thyroid gland (two on each side) **ii) Superior Parathyroids -** from the 4th Pharygneal Arch **Inferior Parathyroids -** from the 3rd Pharyngeal ARch **iii)** Blood supply is solely from the **inferior thyroid artery**

Question 238

**i) Urethral Sphincters:** **Where are the locations and constituents** **ii) Where do the ejaculatory ducts open**

Answer 238

**i) Internal urethral sphincter -** Continuous with bladder musculature. Continuous circular smooth muscles **External urethral sphincter -** Below the prostate **in the deep perineal pouch.** Comprised of **rectourethralis muscle + levator ani muscle** **ii) Ejaculatory ducts** open onto each side of the **Prostatic utricle (blind ended pouch)**

Question 239

**Layers of the scrotum**

Answer 239

**Skin** **Subcutaneous Fascia** **Dartos Fascia** **External Spermatic Fascia** **Cremasteric Fascia** **Internal Spermatic Fascia** **Tunica Vaginalis** (pouch of serous membrane covering testicle. Vagination of the peritoneum. Remnant of the route of descent of testes - processes vaginalis ) **Tunica Albuginea** (fibrous covering of the testes)

Question 240

**Sensory Supply from Common peroneal nerve**

Answer 240

**Common peroneal Nerve - L4-S2** **Sural Communicating Nerve -** Aids the sural nerve. Posterolatearl leg **Lateral Sural Communicating Nerve -** Upper Lateral Leg **Terminal branches:** **Sup peroneal Nerve -** Dorsum of foot **Deep Peroneal nerve -** First Web Space

Question 242

**i) Level of CCA Bifurcation** **ii) Where does ICA enter skull?**

Answer 242

i) C4 - just inferior to hyoid bone ii) Carotid Canal

Question 243

**Neurovascular supply of the penis**

Answer 243

**i) Arteries:** Dorsal arteries, Deep Arteries, Bulbourethral Artery (all from internal pudendal artery) **ii) Veins:** Superficial and Deep Dorsal Veins - Drain into the prostatic venous plexus **iii) Neves:** Dorsal nerve of the penis (Pudendal Nerve) - Sympathetic and sensory Peri-prostatic nerve plexus (parasympathetic)

Question 244

**Contents of Femoral Sheath**

Answer 244

Femoral Artery Femoral Vein Femoral branch of the genitofemoral nerve Lymphatics (+Lymph node of Cloquet)

Question 245

**Tensor Fascia Lata** **i) innervation** **ii) Origin and insertion** **iii) Muscular attachments**

Answer 245

**i)** Innervation - L5+S1 **ii)** Origin - Iliac Crest Insertion - Iliotibial Band **iii) Acts synergistically with the -** Gluteus Maximus, Gluteus Medius, Gluteus Minimus

Question 246

**Occulomotor nerve:** **i)** Arises from? **ii)** Nucleus

Answer 246

**i)** arises from the superior colliculus of the midbrain **ii) Occulomotor Nerve Nucleus** (superior colliculus of the midbrain) - PNS **Edinger Westphal Nucleus** (Superior colliculus of the midbrain) - PNS

Question 247

**DIfference between carotid body and carotid sinus and aortic body**

Answer 247

**i) Carotid Body -** is a chemoreceptor in adventitia of the bifurcation of CCA - Responds to hypoxia, hypercapnea and increased pH --\> Increased BP/HR + RR - Has two cell types - Chief Cells + Substentacular Cells **ii) Carotid Sinus -** Carotid bulb of internal carotid artery. - Baroreceptor **iii) Aortic Body -** Chemoreceptors present along the aortic arch

Question 248

**i)​What is phimosis** **ii) Causes of phimosis**

Answer 248

**i) Phimosis -** Inability to retract foreskin over the glans. **ii)** **Mechanical -** Narrow foreskin, Fusion of forekin with glans, Short frenulum **Inflammatory -** Balnitis, Lichen Sclerosus or balanatis xerotica obliterans, repeated catheterisation

Question 249

**How is parotid gland innervated?**

Answer 249

PNS - Otic Ganglion (Originally tympanic nerve [CN IX branch] --\> form lesser petrosal nerve after tympanic plexus in middle ear --\> go to otic ganglion ---\> Auriculotemporal Nerve to Parotid Gland ) SNS - Superior Cervical Ganglion Sensory- Greater Auricular Nerve

Question 250

**Structures passing through parotid gland**

Answer 250

Facial Nerve (Mandibular Nerve is well seperated from the gland) Retromandibular Vein Auriculotemporal nerve ( Branch of V3) External Carotid Artery

Question 251

**innervation of submandibular gland** Arterial and Venous Supply Lymph Drainage

Answer 251

Sympathetic - superior cervical ganglion Parasympathetic - submandibular ganglion via lingual nerve **Arterial Supply - Facial ARtery** **Venous Drainage - Anterior Facial Vein** Lymph - Deep Cervical + Jugular

Question 252

**Gland Innervation** **Lacrimal** **Submandibular/Sublingual** **Parotid** **What seperates the sublingual from the frenulum of the tongue** **What seperated the submandibular and parotid gland**

Answer 252

**Lacrimal** - Greater petrosla nerve (VII) to the pterygopalatine gaglion. Then lacrimal (V1) to the gland **Submandibular/Sublingual -** Chorda Tympani (VII) to the lingual nerve (V3) to the submandibular ganglion **Parotid -** Glossopharyngeal nerve (IX) to Leseer petrosal nerve --\> Otic Ganglion --\> Auriculotempral Nerve (V3) **Warton's Duct/Lingual Nerve** seperates the sublingual gland from the frenulum of tongue **The Stylomandibular ligament** seperates the submandibular and parotid gland

Question 253

**Scalene Muscles:** **Attachments** **Innervation** **What passes between**

Answer 253

**Anterior** Transverse spinous processes C3-C6 **-\>** First Rib (Scalene Tubercle) *Innervated Anterior Ramiof C5 - C6* Anterior to Anterior Scalene - Subclavian Vein + Phrenic Nerve **Middle** Transverse spinous processes C2-C7 **-\>** First Rib (Scalene Tubercle) *Innervated anterior rami of C3-C8* Between anterior and middle scalene - Subclavian Artery and brachial plexus **Posterior** Transverse spinous processes C5-C7 **-\>** Second Rib *Innervated anterior rami of C6-C8*

Question 254

**Ulna Claw**

Answer 254

**At the Wrist: (Guyon's Canal)** Muscles affected - Medial two lumbricals, Adductor Pollicis, Interossei muscles Claw - Hyperextension of MCPs, Hyperflexion of DIPs **At the elbow: (Cubital Canal)** Muscles affected - Lateral two lumbricals, adductor pollicis, itserossei muscles, Lateral, FDP, FCU (Variable) Claw - Hyperextension of MCPs, The claw is often less severe as the FDP is not spared and therefore doesnt contribute to hyper flexion of the IPs.

Question 255

**Pelvis** **i) Muscles of the lateral walls** **ii) Muscles of the pelvic floor** **iii) What consitutes the levator ani?**

Answer 255

**i)** Piriformis + Obturator Internus **ii)** Pelvic Floor Muscles - Levator Ani, Coccygeus **iii) Levator Ani is made up of 3 distinct muscles (innervated by Pudendal Nerve):** **Puborectalis (+prerectal fibers) - Pubic** **Bones** past the urogenital hiatus to the **rectal hiatus** which it surrounds. **Prerectal** **fibers** are very important in maintaining urinary continence **Pubococcygeus -** Immediately **lateral** to pub**orectalis**. Arise **from** **pubic bones** and attach to the **coccyx/anococcygeal ligament** **Iliococcygeus -** from **ischial spines** to **coccyx/anococcygeal ligament**

Question 256

**Median Nerve Claw**

Answer 256

**Supra-Elbow - Hand of Bennediction (On trying to make a fist)** Intrinsic hand muscle loss: Loss of thumb opposition/ Abduction/ Lateral two lumbricals/ Flexor pillicis brevis Loss of Pronation (with arm extended) + Loss of wrist flexion Appearance - **Hand of bennediction** - on trying to make fist the Lateral three digits are un able to flex due to loss of FDP, FDS. **Ape Hand -** This refers to the **adducted thumb** position resultant throm loss of abductor pollicis longus and wasted thenar aminence

Question 257

**Which pharnygeal arches are the following structures derived from:** **Superior parathyroid glands** **Inferior parathyroid glands**

Answer 257

Superior - Fourth Pharyngeal Arch Inferior - Third Pharyngeal Arch

Question 258

**Nerves associated with pharyngeal arches**

Answer 258

I - Trigeminal II - Facial III - Glossopharyngeal IV - Vagus VI - Vagus + RLN

Question 259

**Coccygeus** **Insertion / Attachment** **Innervation**

Answer 259

**Coccygeus** **Ischial Spines --\> Lateral Sacrum, Coccyx, Sacrospinous Ligament** **Innervation -** Anterior Rami of S4+S5

Question 260

**i) Anatomical Borders of the perineum / Surface borders** **ii) Anal Triangle Contents**

Answer 260

**i) Anatomical** **Anterior -** Pubic Symphsis **Posterior -** Coccyx **Lateral -** Inferior Ischial + Pubic Rami, Sacro tuberous ligament **Roof -** Pelvic Floor **Floor -** Skin and fascia (Divided into urogenital and anal triangless by a line through the ischial tuberosities) **Surface** **Anterior** - Mons **Posterior** - Intergluteal cleft **Lateral** - Medial thigh **ii)** Anal Orifice, External Anal Sphincter, Ischioanal fossae (either side of anal orifice inferior to pelvic diaphragm )

Question 261

**What is in the epidural space?**

Answer 261

Dural Venous Sinuses Spinal nerve roots connective tissue

Question 262

**Urogenital Triangle:** **i) Layers + their contents** **ii) What goes the perineal membrane?**

Answer 262

**i) Deep Perineal Pouch -** Between the **pelvic floor (deep)** and the **perineal membrane (superficial)** Men - Urethra, External urethral sphincter, *bulbourethral glands, transverse perineal muscle* Women - Urethra, External urethral sphincter, *vagina* **Superficial Perineal Pouch -** Between the **perineal membrane (deep)** and the **Deep perineal "Colles'" fascia** **(superficial)** Laterally - Corpus Cavernosus (Crus of clitoris/penis), Medially - Corpus Spongiosum. Ischocavernosus, Bulbospongiosus, Superficial Transverse perineal muscle. **ii) In women -** the vagina and ureter go through the perineal membrane

Question 263

**How does the pundendal neurovascular bundle reach target organs?**

Answer 263

**Pudendal Nerve + Internal Pudendal Artery** Course along the **ischial tuberositeis** within a thickening of **obturator fascia called "Alcock's Canal".** Then travels through each **Ischioanal fossa** (lateral to the anal orifice between the pelvic diaphragm and skin)

Question 264

**What is the perineal body?**

Answer 264

It is an irregular fibromuscular mass acting as a point of attachment for various structures. **Location -** Junctional between urogenital and anal triangles. **Attachments -** Levator Ani Bulbocavernosus Transverse perineal muscles (deep+superficial) External Anal Sphincter Internal Anal sphincter

Question 265

**Arteries in the foot**

Answer 265

**Dorsalis Pedis** (From the Anterior Tibial Artery) - Enters the foot anteriorly over the tarsal bones then moves inferiorly to the sole **anastamosing with the lateral plantar artery** **Posterior Tibial Artery** - Enters sole of foot through **tarsal tunnel** and contributes to **medial and lateral plantar artery** **Deep Plantar Arch** - gives off **common plantar digital arteries** to the digits Derived from both **medial and lateral plantar artery.** **Medial plantar artery** also provides **plantar digital artery** to the **hallux.** **Lateral plantar artery** also proves **plantar digital artery** to the **fifth** toe

Question 266

**What is the portal triad**

Answer 266

Portal Venule, Hepatic Arteriole + Bile Duct

Question 267

**What level does the pulmonary trunk divide?** **How many cusps does the pulmonary valve have?** **What is the pulmonary ligament** **Most anterior structure in hilum?**

Answer 267

**What level does the pulmonary trunk divide?** T5 **How many cusps does the pulmonary valve have?** 3- Anterior, Left + Right **What is the pulmonary ligament** Sheet of parietal + Visceral pleura extending from the medial surface of the lower lobe to the mediastinum just inferior to the hilum - Allows expansion of hilar vessels in times of increased cardiac output **Structures of the hilum:** **Vein is most anterior**

Question 268

**i) Attachments of the diaphragm** **ii) What structures run through central tendon of diaphragm** **iii) Through which ligament does the porta hepatis run?** **iv) Boundaries of the quadrate lobe?**

Answer 268

**i) Xiphisternum** **7-12th Ribs** **Lumbar Vertebrae** (left and right crura) **Central Tendon -** Attached to the fibrous pericardium **ii) Central Tendon:** IVC + R Phrenic Nerve **iii) Hepatoduodenal ligament** contains the porta hepatis **iv) Quadrate Lobe:** R- Gallbladder Fossa L- Umbilical Vein Fossa Posterior - Porta Hepatis

Question 269

**What is the arcuate line?**

Answer 269

**The arcuate line is a:** Horizontal line 1/2 been umbilicus and the pubic crest. **Demarcates the end of the posterior rectus sheath + where the inferior epigastric vessels perforate the rectus abdominus** **Above** the arcuate line: **Anterior Rectus Sheath -** External oblique aponeruosis + Anteria lamina of internal oblique aponeurosis **Posterior Recuts Sheath -** Posterior lamina of internal oblique aponeurosis + tranverses abdominus aponeuoriss **Below** the arcutate line : **Anterior REctus sheath -** combination of EOA, IOA + TAA Behind this the rectus abdominus is in direct contact with the transversalis fascia

Question 270

**Innervation:** i) Of the colon ii) Of the small intestine

Answer 270

**i) Midgut Derived Structures:** **Superior Mesenteric Plexus** - Approximates well to the SMA --\> axxompanying it into the mesentery where it divides to give secondary plexi. It is a **continuation** of the **coeliac** **plexus** (Receives an extra branch from the R Vagus) **Hindgut derived Structures:** **Inferior** **Mesenteric** Plexus : **PNS** - **Pelvic** **Splanchnic** Nerves **SNS** - **Lumbar** **Splanchnic** Nerves **ii) Coeliac plexus -** From the greater + lesser **splanchnic** nerves **and** anterior and posterior **vagal trunks** ---\> gives off hepatic, pancreatic, splenic, gastric, suprarenal plexi, renal, gonadal **and** superior mesenteric plexus.

Question 271

**Tributaries to the IVC**

Answer 271

**Distal -\> Proximal** **L5 -** Two CIV Join **L5-** Median Sacral Vein **L5-L3 -** Lumbar Veins **L3 -** Right Gonadal Vein **L2 -** Renal Veins **L2/L1 -** Right Suprarenal Vein **T12 -** Inferior Phrenic, Left/Middle/Right Hepatic Veins

Question 272

**Adrenal Gland Blood Supply**

Answer 272

**Arterial:** **Superior - Inferior Phrenic** **Middle - Abdominal Aorta** **Inferior - Renal Artery** **Venous:** **Left Adrenal Vein --\> Renal Vein --\> IVC** **Right Adrenal Vein ---\> IVC**

Question 273

**Sympathetic Trunk:** **i) Extent** **ii) How does it communicate with spinal nerves?**

Answer 273

**i) Extends** from T1-L2 **ii) Communicates** with spinal neves through rami communicantes

Question 274

**Duodenum:** **i) What is behind first part** **ii) What is behind third part** **iii) What is in front of third part?** **iv) Behind fourth Part?**

Answer 274

**i) Behind 1st/2nd Part -** Gastroduodenal Artery **ii) Behind 3rd Part -** Aorta / IVC **iii) Anterior to third part -** SMA / SMV **iv) Behind Fourth Part-** Left Renal vein

Question 275

**i) Where do you find diploic veins?** **ii) Arterial supply to temporalis muscle?** **iii)**

Answer 275

i) Diploic veins are found in between the inner and outer layer of cranial bones and drain into the various intracranial sinuses ii) Deep temporal artery - Branch of maxillary artery

Question 276

**i) Thoracic Duct Drains into** **ii) Azygos Vein drains into**

Answer 276

**i) Thoracic Duct** Drains into the left **subclavian** vein (Croses behind the oesophagus from right to left at the vertebral level T4) **Right** **Thoracic Duct/ Subclavian Duct/ Jugular Duct** all drain into the Right **subclavian** vein **ii)** **Azyguos Vein Drains into the** Superior Vena Cava

Question 277

**Small Cardiac Vein Runs with..** **Middle cardiac Vein runs with ..** **Great Cardiac Vein runs with ....**

Answer 277

**Small Cardiac Vein -** Right Coronary Artery **Middle Cardiac Vein -** Posterior Interventricular Artery **Great cardiac vein -** Anterior Interventricular Artery

Question 278

**Hip:** **1) Origin of vastus muscles?** **2) Origin / Insertion of short external rotators?**

Answer 278

**1) Vastus Muscles (Med, Intermedialis, Lat)** all originate from the **intertrochanteric Line** **Lat- Superiorly** **Medialis - Inferiorly** **Interm - In between** **2) OSIQ** **Oburator Internus** **Superior Gemellus** **Inferior GEmellus** **Quadratus Femoris** all **originate** from the **Ischial Tuberosity** in that order and **insert** onto the **greater trochanter**

Question 279

**What is meant by the extensor expansion?**

Answer 279

**The Extensor Digitorum Tendons:** - Flatten as they reach the metacarpophalangeal joints forming **a hood** and **then** **Medial** **Band** attaches to the **middle phalanx** **Two Lateral Bands** attach to the **distal phalanx** **Function -** compound tendinous attachment for the **extensor digitiorum,** **lumbricals and interossei muscles**

Question 280

**What is a GIST?** **Malignant potential?** **How is TK Involved?**

Answer 280

**A tumour of mesenchymal origin** - arising from smooth muscle pacemaker cells of **kajal** **Mutations in the KIT gene** **They have a low malignant potential compared to other GI tumours** **KIT -** encodes a **Tyrosine Kinase** like transmembranous receptor: - Leads to phosphorylation of ADP --\> In turn leading to various effects acting like and **on/off switch ---\> Enzyme changes, Cellular proliferation signalling.**

Question 281

**Pectoralis Major Components + Functions**

Answer 281

**Interbercular Groove --\> Clavicle + Sternum** **Clavicular -** Flexion **Sternum -** Adduction **Also accessory muscle of inspiration**

Question 282

**Relations of pancreas**

Answer 282

**Superior - Splenic ARtery** **Inferior - Third part of duodenum, DJ Flexure** **Anterior - Stomach, Gastro duodenal artery (to head)** **Posterior to body - SMA, AOrta,** **Posterior to neck - IVC SMV**

Question 283

**How do middle ear infections cause intracranial probelms**

Answer 283

**Through Mastoid Air Cells causing local bony erosions.** **OR** **Cholesteatoma leading to bone erosion** **Temporal Abscess / Meningitis** **Sigmois Sinus Thrombosis**